pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	part_d_model_demo	part_d_enhncd_cvrg_demo	mrx_tier_label_list	mrx_tier_benefit_type	mrx_tier_drug_type	mrx_tier_includes	mrx_tier_cstshr_struct_type	mrx_tier_id	mrx_tier_type_id	mrx_tier_locat_rstd	mrx_tier_locat_rsplt	mrx_tier_locat_oon	mrx_tier_locat_mostd	mrx_tier_locat_mosplt	mrx_tier_locat_ltc	mrx_tier_rstd_1m_num	mrx_tier_rstd_2m_num	mrx_tier_rstd_3m_num	mrx_tier_rsplt_1m_num	mrx_tier_rsplt_2m_num	mrx_tier_rsplt_3m_num	mrx_tier_extd_days_yn	mrx_tier_extd_first_fill	mrx_tier_mostd_1m_num	mrx_tier_mostd_2m_num	mrx_tier_mostd_3m_num	mrx_tier_mosplt_1m_num	mrx_tier_mosplt_2m_num	mrx_tier_mosplt_3m_num	mrx_tier_oonp_1m_num	mrx_tier_oonp_othnumn	mrx_tier_ltcp_1m	mrx_tier_rstd_copay_1m	mrx_tier_rstd_copay_2m	mrx_tier_rstd_copay_3m	mrx_tier_rstd_coins_avg_1m	mrx_tier_rstd_coins_1m	mrx_tier_rstd_coins_2m	mrx_tier_rstd_coins_3m	mrx_tier_rsstd_copay_1m	mrx_tier_rsstd_copay_2m	mrx_tier_rsstd_copay_3m	mrx_tier_rsstd_coins_avg_1m	mrx_tier_rsstd_coins_1m	mrx_tier_rsstd_coins_2m	mrx_tier_rsstd_coins_3m	mrx_tier_rspfd_copay_1m	mrx_tier_rspfd_copay_2m	mrx_tier_rspfd_copay_3m	mrx_tier_rspfd_coins_avg_1m	mrx_tier_rspfd_coins_1m	mrx_tier_rspfd_coins_2m	mrx_tier_rspfd_coins_3m	mrx_tier_mostd_copay_1m	mrx_tier_mostd_copay_2m	mrx_tier_mostd_copay_3m	mrx_tier_mostd_coins_1m	mrx_tier_mostd_coins_2m	mrx_tier_mostd_coins_3m	mrx_tier_mosstd_copay_1m	mrx_tier_mosstd_copay_2m	mrx_tier_mosstd_copay_3m	mrx_tier_mosstd_coins_1m	mrx_tier_mosstd_coins_2m	mrx_tier_mosstd_coins_3m	mrx_tier_mospfd_copay_1m	mrx_tier_mospfd_copay_2m	mrx_tier_mospfd_copay_3m	mrx_tier_mospfd_coins_1m	mrx_tier_mospfd_coins_2m	mrx_tier_mospfd_coins_3m	mrx_tier_oonp_copay_1m	mrx_tier_oonp_copay_othnum	mrx_tier_oonp_coins_1m	mrx_tier_oonp_coins_othnum	mrx_tier_ltcp_copay_1m	mrx_tier_ltcp_coins_1m	mrx_tier_rstd_copay_daily	mrx_tier_rsstd_copay_daily	mrx_tier_rspfd_copay_daily	mrx_tier_mostd_copay_daily	mrx_tier_mosstd_copay_daily	mrx_tier_mospfd_copay_daily	mrx_tier_ltcp_copay_daily	mrx_tier_form_model_desc	mrx_tier_includes_mmp	mrx_tier_copay_amt_rstd_mmpmin	mrx_tier_copay_amt_rstd_mmpmax	mrx_tier_copay_amt_oon_mmpmin	mrx_tier_copay_amt_oon_mmpmax	mrx_tier_copay_amt_mstd_mmpmin	mrx_tier_copay_amt_mstd_mmpmax	mrx_tier_copay_amt_ltc_mmpmin	mrx_tier_copay_amt_ltc_mmpmax	mrx_tier_gap_cost_share	mrx_tier_gap_part_drugs	mrx_tier_gap_part_includes
H0022	001	0	1	48	05	H0022_001_0	3			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0022	001	0	1	48	05	H0022_001_0	3			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0022	001	0	1	48	05	H0022_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0028	007	0	1	01	01	H0028_007_0	6		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	6		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	6		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	6		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	6		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_011_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_011_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_011_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	011	0	1	01	01	H0028_011_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	013	0	1	01	01	H0028_013_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	014	0	1	01	01	H0028_014_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_0	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	015	0	1	01	01	H0028_015_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	016	0	1	01	01	H0028_016_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	017	0	1	01	01	H0028_017_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_0	4		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_0	4		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	018	0	1	01	01	H0028_018_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	019	0	1	01	01	H0028_019_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	021	0	1	01	01	H0028_021_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	023	0	1	01	01	H0028_023_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	024	0	1	01	01	H0028_024_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	1	1	01	01	H0028_025_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	025	2	1	01	01	H0028_025_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	027	0	1	01	01	H0028_027_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	028	0	1	01	01	H0028_028_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	029	0	1	01	01	H0028_029_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	030	0	1	01	01	H0028_030_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	031	0	1	01	01	H0028_031_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	032	0	1	01	01	H0028_032_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_0	5		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_0	5		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_0	5		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_0	5		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	033	0	1	01	01	H0028_033_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	034	0	1	01	01	H0028_034_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	035	0	1	01	01	H0028_035_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	036	0	1	01	01	H0028_036_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	037	0	1	01	01	H0028_037_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	039	0	1	01	01	H0028_039_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	041	0	1	01	01	H0028_041_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	042	0	1	01	01	H0028_042_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	1	1	01	01	H0028_043_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	043	2	1	01	01	H0028_043_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	044	0	1	01	01	H0028_044_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	045	0	1	01	01	H0028_045_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	046	0	1	01	01	H0028_046_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	047	0	1	01	01	H0028_047_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	1	1	01	01	H0028_048_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	048	2	1	01	01	H0028_048_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0062	001	0	1	01	01	H0062_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	36.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					14.00	28.00	42.00					14.00	28.00	42.00																19.00				19.00			0.63	0.47	0.47			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	36.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0074	001	0	1	04	01	H0074_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0074	001	0	1	04	01	H0074_001_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H0074	001	0	1	04	01	H0074_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0074	001	0	1	04	01	H0074_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0074	001	0	1	04	01	H0074_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0074	001	0	1	04	01	H0074_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	001	0	1	04	01	H0088_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	001	0	1	04	01	H0088_001_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0088	001	0	1	04	01	H0088_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	001	0	1	04	01	H0088_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	001	0	1	04	01	H0088_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.85	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	001	0	1	04	01	H0088_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	002	0	1	04	01	H0088_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	002	0	1	04	01	H0088_002_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H0088	002	0	1	04	01	H0088_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	002	0	1	04	01	H0088_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	002	0	1	04	01	H0088_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0088	002	0	1	04	01	H0088_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0104	012	0	1	04	01	H0104_012_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								11.00		33.00					4.00		8.00					4.00		8.00																11.00				11.00			0.36	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	7		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					13.00		26.00					13.00		26.00																20.00				20.00			0.66	0.43	0.43			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		80.00					40.00		80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											96.00	50		50				88.00	45		45				45		45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	7		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	7		N	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	7		N	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0104	014	0	1	04	01	H0104_014_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								11.00		33.00					4.00		8.00					4.00		8.00																11.00				11.00			0.36	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					13.00		26.00					13.00		26.00																20.00				20.00			0.66	0.43	0.43			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		80.00					40.00		80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											97.00	50		50				87.00	45		45				45		45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6		N	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6		N	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0104	015	0	1	04	01	H0104_015_0	3		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		30.00					3.00		6.00					3.00		6.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					8.00		16.00					8.00		16.00																15.00				15.00			0.50	0.26	0.26			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		80.00					40.00		80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											74.00	50		50				69.00	45		45				45		45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3		N	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	3		N	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0107	003	0	1	04	01	H0107_003_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	003	0	1	04	01	H0107_003_0	5		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0107	003	0	1	04	01	H0107_003_0	5		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	003	0	1	04	01	H0107_003_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	003	0	1	04	01	H0107_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	003	0	1	04	01	H0107_003_0	5		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	5		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0107	004	0	1	04	01	H0107_004_0	5		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0107	004	0	1	04	01	H0107_004_0	5		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												26		26					26		26												26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	001	0	1	04	01	H0111_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	001	0	1	04	01	H0111_001_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H0111	001	0	1	04	01	H0111_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	001	0	1	04	01	H0111_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	001	0	1	04	01	H0111_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.70	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	001	0	1	04	01	H0111_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	002	0	1	04	01	H0111_002_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	002	0	1	04	01	H0111_002_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H0111	002	0	1	04	01	H0111_002_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	002	0	1	04	01	H0111_002_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	002	0	1	04	01	H0111_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.24	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	002	0	1	04	01	H0111_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	003	0	1	04	01	H0111_003_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	003	0	1	04	01	H0111_003_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0111	003	0	1	04	01	H0111_003_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	003	0	1	04	01	H0111_003_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	003	0	1	04	01	H0111_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.85	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	003	0	1	04	01	H0111_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	004	0	1	04	01	H0111_004_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	004	0	1	04	01	H0111_004_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	004	0	1	04	01	H0111_004_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	004	0	1	04	01	H0111_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.51	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	004	0	1	04	01	H0111_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	005	0	1	04	01	H0111_005_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	005	0	1	04	01	H0111_005_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0111	005	0	1	04	01	H0111_005_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	005	0	1	04	01	H0111_005_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0111	005	0	1	04	01	H0111_005_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	005	0	1	04	01	H0111_005_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0111	005	0	1	04	01	H0111_005_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0137	001	0	1	48	05	H0137_001_0	4			Preferred Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	4			Generic Drugs	4	01			2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	4			Preferred Brand Drugs	4	10			3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	4			Non-Preferred Brand Drugs	4	11			4	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Preferred Generic Drugs, Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0148	001	0	1	48	05	H0148_001_0	6			Preferred Generic Drugs	4	01			1	1	111		10	100		1	30	60	100				2	2			100					10	31																																														0.00						0.00	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0148	001	0	1	48	05	H0148_001_0	6			Generic Drugs	4	01			2	1	111		10	100		1	30	60	90				2	2			90					10	31																																																					Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.70					0.00	3.70			
H0148	001	0	1	48	05	H0148_001_0	6			Brand Drugs	4	10			3	1	111		10	100		1	30	60	90				2	2			90					10	31																																																					Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.20					0.00	9.20			
H0148	001	0	1	48	05	H0148_001_0	6			Non-Medicare Rx/OTC Drugs	4	11			4	1	010		10			1	30															10	31																																														0.00						0.00	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H0148	002	0	1	48	05	H0148_002_0	6			Preferred Generic Drugs	4	01			1	1	111		10	100		1	30	60	100				2	2			100					10	31																																														0.00						0.00	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0148	002	0	1	48	05	H0148_002_0	6			Generic Drugs	4	01			2	1	111		10	100		1	30	60	90				2	2			90					10	31																																																					Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.70					0.00	3.70			
H0148	002	0	1	48	05	H0148_002_0	6			Brand Drugs	4	10			3	1	111		10	100		1	30	60	90				2	2			90					10	31																																																					Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.20					0.00	9.20			
H0148	002	0	1	48	05	H0148_002_0	6			Non-Medicare Rx/OTC Drugs	4	11			4	1	010		10			1	30															10	31																																														0.00						0.00	Preferred Generic Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H0154	011	0	1	01	01	H0154_011_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					8.00	16.00	24.00											8.00	16.00	24.00				7.00	13.50	16.00				8.00				8.00			0.27	0.27		0.27	0.23	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				85.00	170.00	200.00				100.00				100.00			3.33	3.33		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	4		N	Preferred Generic	3	11	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	4		N	Generic	3	11	1	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	4		N	Preferred Brand	3	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	4		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					12.00	24.00	36.00											12.00	24.00	36.00				10.00	20.00	24.00				12.00				12.00			0.40	0.40		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				85.00	170.00	200.00				100.00				100.00			3.33	3.33		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					12.00	24.00	36.00											12.00	24.00	36.00				10.00	20.00	24.00				12.00				12.00			0.40	0.40		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				85.00	170.00	200.00				100.00				100.00			3.33	3.33		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	4		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	30						1.00	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					12.00	24.00	36.00											12.00	24.00	36.00				10.00	20.00	24.00				12.00				12.00			0.40	0.40		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				85.00	170.00	200.00				100.00				100.00			3.33	3.33		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	4		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	30						1.00	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	016	0	1	01	01	H0154_016_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	016	0	1	01	01	H0154_016_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					12.00	24.00	36.00											12.00	24.00	36.00				10.00	20.00	24.00				12.00				12.00			0.40	0.40		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	016	0	1	01	01	H0154_016_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	016	0	1	01	01	H0154_016_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											64.07	50	50	50				64.07	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	016	0	1	01	01	H0154_016_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	017	0	1	01	01	H0154_017_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	017	0	1	01	01	H0154_017_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					12.00	24.00	36.00											12.00	24.00	36.00				10.00	20.00	24.00				12.00				12.00			0.40	0.40		0.40	0.33	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	017	0	1	01	01	H0154_017_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	017	0	1	01	01	H0154_017_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				85.00	170.00	200.00				100.00				100.00			3.33	3.33		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	017	0	1	01	01	H0154_017_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	30						1.00	30																							30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	018	0	1	01	01	H0154_018_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	018	0	1	01	01	H0154_018_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					8.00	16.00	24.00											8.00	16.00	24.00				7.00	13.50	16.00				8.00				8.00			0.27	0.27		0.27	0.23	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	018	0	1	01	01	H0154_018_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				39.50	78.50	94.00				47.00				47.00			1.57	1.57		1.57	1.32	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	018	0	1	01	01	H0154_018_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				85.00	170.00	200.00				100.00				100.00			3.33	3.33		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	018	0	1	01	01	H0154_018_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	019	0	1	01	01	H0154_019_0	4		N	Preferred Generic	3	11	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	019	0	1	01	01	H0154_019_0	4		N	Generic	3	11	1	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	019	0	1	01	01	H0154_019_0	4		N	Preferred Brand	3	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	019	0	1	01	01	H0154_019_0	4		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	019	0	1	01	01	H0154_019_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	002	0	1	01	01	H0174_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	003	0	1	01	01	H0174_003_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	003	0	1	01	01	H0174_003_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0174	003	0	1	01	01	H0174_003_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	003	0	1	01	01	H0174_003_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	003	0	1	01	01	H0174_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	003	0	1	01	01	H0174_003_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	004	0	1	01	01	H0174_004_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	004	0	1	01	01	H0174_004_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	004	0	1	01	01	H0174_004_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	004	0	1	01	01	H0174_004_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.91	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	004	0	1	01	01	H0174_004_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	005	0	1	02	01	H0174_005_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	005	0	1	02	01	H0174_005_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0174	005	0	1	02	01	H0174_005_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	005	0	1	02	01	H0174_005_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		60.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	005	0	1	02	01	H0174_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		170.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	005	0	1	02	01	H0174_005_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	006	0	1	01	01	H0174_006_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	006	0	1	01	01	H0174_006_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	006	0	1	01	01	H0174_006_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	006	0	1	01	01	H0174_006_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				99.34	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	006	0	1	01	01	H0174_006_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	007	0	1	01	01	H0174_007_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	007	0	1	01	01	H0174_007_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	007	0	1	01	01	H0174_007_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		60.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	007	0	1	01	01	H0174_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	007	0	1	01	01	H0174_007_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	008	0	1	01	01	H0174_008_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	008	0	1	01	01	H0174_008_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0174	008	0	1	01	01	H0174_008_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	008	0	1	01	01	H0174_008_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0174	008	0	1	01	01	H0174_008_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	008	0	1	01	01	H0174_008_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	008	0	1	01	01	H0174_008_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	008	0	1	01	01	H0174_008_0	5		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0174	008	0	1	01	01	H0174_008_0	5		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H0174	009	0	1	01	01	H0174_009_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	009	0	1	01	01	H0174_009_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	009	0	1	01	01	H0174_009_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	009	0	1	01	01	H0174_009_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.16	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	009	0	1	01	01	H0174_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	010	0	1	01	01	H0174_010_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	010	0	1	01	01	H0174_010_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0174	010	0	1	01	01	H0174_010_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	010	0	1	01	01	H0174_010_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		60.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	010	0	1	01	01	H0174_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0174	010	0	1	01	01	H0174_010_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0192	001	0	1	48	05	H0192_001_0	4			Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0192	001	0	1	48	05	H0192_001_0	4			Brand Drugs	4	11			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0192	001	0	1	48	05	H0192_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0270	001	0	1	04	01	H0270_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	001	0	1	04	01	H0270_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	001	0	1	04	01	H0270_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	001	0	1	04	01	H0270_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	001	0	1	04	01	H0270_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	002	0	1	04	01	H0270_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	002	0	1	04	01	H0270_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	002	0	1	04	01	H0270_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		92.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	002	0	1	04	01	H0270_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.61	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0270	002	0	1	04	01	H0270_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	001	0	1	01	01	H0292_001_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0292	002	0	1	01	01	H0292_002_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	002	0	1	04	01	H0294_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				265.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	004	0	1	04	01	H0294_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				257.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	010	0	1	04	01	H0294_010_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	010	0	1	04	01	H0294_010_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				274.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	011	0	1	04	01	H0294_011_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	011	0	1	04	01	H0294_011_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				241.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	012	0	1	04	01	H0294_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	012	0	1	04	01	H0294_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				313.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	015	0	1	04	01	H0294_015_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	015	0	1	04	01	H0294_015_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											260.00	28						175.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						20.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						20.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	016	0	1	04	01	H0294_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	016	0	1	04	01	H0294_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				283.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0294	017	0	1	04	01	H0294_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	017	0	1	04	01	H0294_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				225.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	12		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	12		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	9.00	9.00	9.00																					9.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	12		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	12		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	12		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	12		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	9.00	9.00	9.00																					9.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	12		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	12		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	13		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	13		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	9.00	9.00	9.00																					9.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	13		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	13		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	13		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	009	0	1	01	01	H0302_009_0	12		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	009	0	1	01	01	H0302_009_0	12		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	9.00	9.00	9.00																					9.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	009	0	1	01	01	H0302_009_0	12		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	009	0	1	01	01	H0302_009_0	12		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	009	0	1	01	01	H0302_009_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0332	002	0	1	01	01	H0332_002_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	12.50											10.00	20.00	30.00				5.00	10.00	12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	12.50											10.00	20.00	30.00				5.00	10.00	12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0332	002	0	1	01	01	H0332_002_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	100.00											45.00	90.00	135.00				40.00	80.00	100.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	200.00											90.00	180.00	270.00				80.00	160.00	200.00				90.00				90.00			3.00	2.67		3.00	2.67	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0332	004	0	1	02	01	H0332_004_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	12.50											10.00	20.00	30.00				5.00	10.00	12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	12.50											10.00	20.00	30.00				5.00	10.00	12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0332	004	0	1	02	01	H0332_004_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	100.00											45.00	90.00	135.00				40.00	80.00	100.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	200.00											90.00	180.00	270.00				80.00	160.00	200.00				90.00				90.00			3.00	2.67		3.00	2.67	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	008	0	1	02	01	H0332_008_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	008	0	1	02	01	H0332_008_0	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0332	008	0	1	02	01	H0332_008_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	12.50											10.00	20.00	30.00				5.00	10.00	12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	008	0	1	02	01	H0332_008_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	12.50											10.00	20.00	30.00				5.00	10.00	12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0332	008	0	1	02	01	H0332_008_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	100.00											45.00	90.00	135.00				40.00	80.00	100.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	008	0	1	02	01	H0332_008_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								90.00	180.00	270.00					80.00	160.00	200.00											90.00	180.00	270.00				80.00	160.00	200.00				90.00				90.00			3.00	2.67		3.00	2.67	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0332	008	0	1	02	01	H0332_008_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0336	001	0	1	48	05	H0336_001_0	2			Generic Drugs	4	01			1	1	110		01	110		1	30		90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	2			Brand Drugs	4	10			2	1	110		01	110		1	30		90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	2			Non-Medicare Rx Drugs	4	11			3	1	110		01	110		1	30		90				1	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0336	001	0	1	48	05	H0336_001_0	2			Non-Medicare OTC Drugs	4	11			4	1	110		01	110		1	30		90				1	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0342	001	0	1	04	01	H0342_001_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H0342	001	0	1	04	01	H0342_001_0	9		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				0.00			0.50	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H0342	001	0	1	04	01	H0342_001_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H0342	001	0	1	04	01	H0342_001_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H0342	001	0	1	04	01	H0342_001_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H0342	001	0	1	04	01	H0342_001_0	9		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H0351	038	0	1	01	01	H0351_038_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0351	052	0	1	01	01	H0351_052_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	052	0	1	01	01	H0351_052_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0351	053	0	1	01	01	H0351_053_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	053	0	1	01	01	H0351_053_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0351	054	0	1	01	01	H0351_054_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	054	0	1	01	01	H0351_054_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	054	0	1	01	01	H0351_054_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	054	0	1	01	01	H0351_054_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	054	0	1	01	01	H0351_054_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0351	054	0	1	01	01	H0351_054_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0354	001	0	1	01	01	H0354_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	001	0	1	01	01	H0354_001_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	001	0	1	01	01	H0354_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											717.44	33						652.61	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	024	0	1	01	01	H0354_024_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	024	0	1	01	01	H0354_024_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											588.67	33						638.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_027_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H0354	027	0	1	01	01	H0354_027_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_027_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H0354	027	0	1	01	01	H0354_027_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_027_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_027_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											726.35	33						635.74	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	027	0	1	01	01	H0354_027_0	5		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					9.00	18.00	18.00											11.00	22.00	33.00				9.00	18.00	18.00				11.00				11.00			0.37	0.30		0.37	0.30	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0354	028	0	1	01	01	H0354_028_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	028	0	1	01	01	H0354_028_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	028	0	1	01	01	H0354_028_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	028	0	1	01	01	H0354_028_0	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0354	028	0	1	01	01	H0354_028_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	028	0	1	01	01	H0354_028_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	028	0	1	01	01	H0354_028_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											731.77	33						620.85	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	7		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		36.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	7		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											51.00	50		50				46.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	001	0	1	02	01	H0422_001_0	7		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1443.00	25		25				1443.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	002	0	1	02	01	H0422_002_0	7		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		36.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	002	0	1	02	01	H0422_002_0	7		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00					20.00			20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	002	0	1	02	01	H0422_002_0	7		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	002	0	1	02	01	H0422_002_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											55.00	50		50				50.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0422	002	0	1	02	01	H0422_002_0	7		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2141.00	33		33				2141.00	33		33										33		33				33		33				33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	001	0	1	01	01	H0432_001_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	001	0	1	01	01	H0432_001_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	001	0	1	01	01	H0432_001_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0432	001	0	1	01	01	H0432_001_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	001	0	1	01	01	H0432_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	001	0	1	01	01	H0432_001_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				349.00	32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	002	0	1	01	01	H0432_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	002	0	1	01	01	H0432_002_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	002	0	1	01	01	H0432_002_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0432	002	0	1	01	01	H0432_002_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	002	0	1	01	01	H0432_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	002	0	1	01	01	H0432_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				428.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	01	01	H0432_003_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	01	01	H0432_003_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	01	01	H0432_003_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0432	003	0	1	01	01	H0432_003_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	01	01	H0432_003_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	003	0	1	01	01	H0432_003_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				432.00	32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	01	01	H0432_004_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	01	01	H0432_004_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	01	01	H0432_004_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0432	004	0	1	01	01	H0432_004_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	01	01	H0432_004_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	004	0	1	01	01	H0432_004_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	01	01	H0432_010_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	01	01	H0432_010_0	5		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								18.00		54.00					3.00		6.00													54.00						6.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	01	01	H0432_010_0	5		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								18.00		54.00					3.00		6.00													54.00						6.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0432	010	0	1	01	01	H0432_010_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	01	01	H0432_010_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0432	010	0	1	01	01	H0432_010_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											444.00	32						294.00	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.59	36	36	36				89.85	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											634.02	27						555.25	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.59	36	36	36				89.85	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											634.02	27						555.25	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	006	0	1	02	01	H0439_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											683.59	33						693.43	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	007	0	1	01	01	H0439_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											761.14	33						712.30	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	6.00											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	24.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	008	0	1	01	01	H0439_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											803.26	31						724.28	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	009	0	1	01	01	H0439_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											788.24	33						661.80	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	010	0	1	01	01	H0439_010_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											748.86	31						659.83	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					0.00	0.00	0.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	24.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	011	0	1	01	01	H0439_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											846.55	33						778.48	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	001	0	1	04	01	H0473_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	003	0	1	04	01	H0473_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	004	0	1	04	01	H0473_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	005	0	1	04	01	H0473_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0473	006	0	1	04	01	H0473_006_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0480	001	0	1	48	05	H0480_001_0	5			Generic Drugs	4	01			1	1	110		01	100		1	30		90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0480	001	0	1	48	05	H0480_001_0	5			Brand Drugs	4	10			2	1	110		01	100		1	30		90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0480	001	0	1	48	05	H0480_001_0	5			Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	100		1	30		90				1	1			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0482	001	0	1	01	01	H0482_001_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	001	0	1	01	01	H0482_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0482	002	0	1	01	01	H0482_002_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0504	015	0	1	01	01	H0504_015_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	7		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					5.00	10.00	7.50							7.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					5.00	10.00	7.50							7.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					38.00	76.00	95.00							95.00																47.00				47.00			1.57	1.27				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	7		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	7		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	026	0	1	01	01	H0504_026_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	026	0	1	01	01	H0504_026_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	028	0	1	01	01	H0504_028_0	7		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					5.00	10.00	7.50							7.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	7		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	36.00					5.00	10.00	7.50							7.50																12.00				12.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	028	0	1	01	01	H0504_028_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	029	0	1	01	01	H0504_029_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	031	0	1	01	01	H0504_031_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					12.00	24.00	18.00							18.00																20.00				20.00			0.67	0.40				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	037	0	1	01	01	H0504_037_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					12.00	24.00	18.00							18.00																20.00				20.00			0.67	0.40				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1060.64	30						1060.64	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	038	0	1	01	01	H0504_038_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					15.00	30.00	22.50							22.50																20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	038	0	1	01	01	H0504_038_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	039	0	1	01	01	H0504_039_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								15.00	30.00	45.00					10.00	20.00	15.00							15.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								15.00	30.00	45.00					10.00	20.00	15.00							15.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	039	0	1	01	01	H0504_039_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	039	0	1	01	01	H0504_039_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	040	0	1	01	01	H0504_040_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								10.00	20.00	30.00					3.00	6.00	4.50							4.50																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								10.00	20.00	30.00					3.00	6.00	4.50							4.50																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	040	0	1	01	01	H0504_040_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					35.00	70.00	87.50							87.50																47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	040	0	1	01	01	H0504_040_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	041	0	1	01	01	H0504_041_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					12.00	24.00	18.00							18.00																20.00				20.00			0.67	0.40				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	041	0	1	01	01	H0504_041_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	042	0	1	01	01	H0504_042_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	042	0	1	01	01	H0504_042_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	042	0	1	01	01	H0504_042_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					12.00	24.00	18.00							18.00																20.00				20.00			0.67	0.40				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	042	0	1	01	01	H0504_042_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	042	0	1	01	01	H0504_042_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	042	0	1	01	01	H0504_042_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1063.53	31						1063.53	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	043	0	1	01	01	H0504_043_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	043	0	1	01	01	H0504_043_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	043	0	1	01	01	H0504_043_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								10.00	20.00	30.00					3.00	6.00	4.50							4.50																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	043	0	1	01	01	H0504_043_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								10.00	20.00	30.00					3.00	6.00	4.50							4.50																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	043	0	1	01	01	H0504_043_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					35.00	70.00	87.50							87.50																47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	043	0	1	01	01	H0504_043_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	043	0	1	01	01	H0504_043_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	044	0	1	01	01	H0504_044_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	044	0	1	01	01	H0504_044_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	044	0	1	01	01	H0504_044_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	51.00					10.00	20.00	15.00							15.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	044	0	1	01	01	H0504_044_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	044	0	1	01	01	H0504_044_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	044	0	1	01	01	H0504_044_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	045	0	1	01	01	H0504_045_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	045	0	1	01	01	H0504_045_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	045	0	1	01	01	H0504_045_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	51.00					10.00	20.00	15.00							15.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	045	0	1	01	01	H0504_045_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	045	0	1	01	01	H0504_045_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	045	0	1	01	01	H0504_045_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	046	0	1	01	01	H0504_046_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	046	0	1	01	01	H0504_046_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	046	0	1	01	01	H0504_046_0	7		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	046	0	1	01	01	H0504_046_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	046	0	1	01	01	H0504_046_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	046	0	1	01	01	H0504_046_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	047	0	1	01	01	H0504_047_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	047	0	1	01	01	H0504_047_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0504	047	0	1	01	01	H0504_047_0	7		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								18.00	36.00	54.00					10.00	20.00	15.00							15.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	047	0	1	01	01	H0504_047_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	047	0	1	01	01	H0504_047_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	047	0	1	01	01	H0504_047_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	002	0	1	01	01	H0523_002_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	002	0	1	01	01	H0523_002_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	002	0	1	01	01	H0523_002_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	002	0	1	01	01	H0523_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	002	0	1	01	01	H0523_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	002	0	1	01	01	H0523_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											695.79	33						521.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	022	0	1	01	01	H0523_022_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	022	0	1	01	01	H0523_022_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	022	0	1	01	01	H0523_022_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	022	0	1	01	01	H0523_022_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	022	0	1	01	01	H0523_022_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	022	0	1	01	01	H0523_022_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	022	0	1	01	01	H0523_022_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											842.04	33						618.27	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	031	0	1	01	01	H0523_031_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	031	0	1	01	01	H0523_031_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	031	0	1	01	01	H0523_031_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	031	0	1	01	01	H0523_031_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	031	0	1	01	01	H0523_031_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	031	0	1	01	01	H0523_031_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	031	0	1	01	01	H0523_031_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											729.48	33						504.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	052	0	1	01	01	H0523_052_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	052	0	1	01	01	H0523_052_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	052	0	1	01	01	H0523_052_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	052	0	1	01	01	H0523_052_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	052	0	1	01	01	H0523_052_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	052	0	1	01	01	H0523_052_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	052	0	1	01	01	H0523_052_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											603.68	33						443.77	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	061	0	1	01	01	H0523_061_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	061	0	1	01	01	H0523_061_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	061	0	1	01	01	H0523_061_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	061	0	1	01	01	H0523_061_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	061	0	1	01	01	H0523_061_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	061	0	1	01	01	H0523_061_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0523	061	0	1	01	01	H0523_061_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											614.53	33						427.56	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0524	002	0	2	01	01	H0524_002_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			0.00	0.00	0.00																7.00				7.00		0.23			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	7.00	14.00	21.00																			0.00	0.00	0.00																7.00				7.00		0.23			0.00			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	8		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	8		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	8		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				783.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	8		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	8		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				732.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				687.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				761.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	8		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				689.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				665.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				756.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				768.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				740.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	10		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	10		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	10		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	10		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				643.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	10		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	10		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				685.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				788.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				723.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				712.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				673.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				762.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.16			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.16			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				1002.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				742.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.16			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.16			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				682.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.16			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.16			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				873.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.16			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.16			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				662.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	054	0	1	01	01	H0524_054_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	054	0	1	01	01	H0524_054_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			10.00	20.00	20.00																12.00				12.00		0.40			0.33			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			10.00	20.00	20.00																12.00				12.00		0.40			0.33			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	054	0	1	01	01	H0524_054_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				714.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	054	0	1	01	01	H0524_054_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	059	0	1	01	01	H0524_059_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	059	0	1	01	01	H0524_059_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	059	0	1	01	01	H0524_059_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				757.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	059	0	1	01	01	H0524_059_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	060	0	1	01	01	H0524_060_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	060	0	1	01	01	H0524_060_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	060	0	1	01	01	H0524_060_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				834.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	060	0	1	01	01	H0524_060_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	061	0	1	01	01	H0524_061_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	061	0	1	01	01	H0524_061_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	061	0	1	01	01	H0524_061_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	061	0	1	01	01	H0524_061_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	061	0	1	01	01	H0524_061_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	061	0	1	01	01	H0524_061_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	061	0	1	01	01	H0524_061_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				745.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	061	0	1	01	01	H0524_061_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	061	0	1	01	01	H0524_061_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	062	0	1	01	01	H0524_062_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	6.00	12.00	18.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	062	0	1	01	01	H0524_062_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				2	2	30	60	100				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	062	0	1	01	01	H0524_062_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31				683.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	062	0	1	01	01	H0524_062_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0543	001	0	1	01	01	H0543_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						30.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						30.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	001	0	1	01	01	H0543_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				404.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	013	0	1	01	01	H0543_013_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	013	0	1	01	01	H0543_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				319.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	019	0	1	01	01	H0543_019_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						15.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						15.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	019	0	1	01	01	H0543_019_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				354.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	022	0	1	01	01	H0543_022_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	022	0	1	01	01	H0543_022_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				305.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	028	0	1	01	01	H0543_028_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				176.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	029	0	1	01	01	H0543_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				198.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	032	0	1	01	01	H0543_032_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	032	0	1	01	01	H0543_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				277.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	035	0	1	01	01	H0543_035_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	035	0	1	01	01	H0543_035_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				384.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	036	0	1	01	01	H0543_036_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				277.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	060	0	1	01	01	H0543_060_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	060	0	1	01	01	H0543_060_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				288.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	070	0	1	01	01	H0543_070_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				300.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	086	0	1	01	01	H0543_086_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				273.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	089	0	1	01	01	H0543_089_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				349.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	138	0	1	01	01	H0543_138_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	138	0	1	01	01	H0543_138_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				444.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	140	0	1	01	01	H0543_140_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				330.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	144	0	1	01	01	H0543_144_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	144	0	1	01	01	H0543_144_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				361.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	145	0	1	01	01	H0543_145_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	145	0	1	01	01	H0543_145_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				345.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	146	0	1	01	01	H0543_146_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				361.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	147	0	1	01	01	H0543_147_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				388.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	148	0	1	01	01	H0543_148_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				497.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	151	0	1	01	01	H0543_151_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	151	0	1	01	01	H0543_151_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				416.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	152	0	1	01	01	H0543_152_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	152	0	1	01	01	H0543_152_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				305.00	32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	158	0	1	01	01	H0543_158_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	158	0	1	01	01	H0543_158_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	158	0	1	01	01	H0543_158_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	158	0	1	01	01	H0543_158_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	158	0	1	01	01	H0543_158_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	158	0	1	01	01	H0543_158_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				313.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	163	0	1	01	01	H0543_163_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	163	0	1	01	01	H0543_163_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				323.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	01	01	H0543_164_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	01	01	H0543_164_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	164	0	1	01	01	H0543_164_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	01	01	H0543_164_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	164	0	1	01	01	H0543_164_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	01	01	H0543_164_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	164	0	1	01	01	H0543_164_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				477.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	01	01	H0543_165_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	01	01	H0543_165_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	165	0	1	01	01	H0543_165_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	01	01	H0543_165_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	165	0	1	01	01	H0543_165_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	01	01	H0543_165_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	165	0	1	01	01	H0543_165_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				409.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	01	01	H0543_166_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	01	01	H0543_166_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	166	0	1	01	01	H0543_166_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	01	01	H0543_166_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	166	0	1	01	01	H0543_166_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	01	01	H0543_166_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	166	0	1	01	01	H0543_166_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				372.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	01	01	H0543_167_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	01	01	H0543_167_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	167	0	1	01	01	H0543_167_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	01	01	H0543_167_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	167	0	1	01	01	H0543_167_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	01	01	H0543_167_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	167	0	1	01	01	H0543_167_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				478.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	168	0	1	01	01	H0543_168_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	168	0	1	01	01	H0543_168_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	168	0	1	01	01	H0543_168_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				478.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	169	0	1	01	01	H0543_169_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	169	0	1	01	01	H0543_169_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	169	0	1	01	01	H0543_169_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				445.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	170	0	1	01	01	H0543_170_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	170	0	1	01	01	H0543_170_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	170	0	1	01	01	H0543_170_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				317.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	175	0	1	01	01	H0543_175_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	175	0	1	01	01	H0543_175_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	175	0	1	01	01	H0543_175_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	175	0	1	01	01	H0543_175_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	175	0	1	01	01	H0543_175_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	175	0	1	01	01	H0543_175_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				308.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	176	0	1	01	01	H0543_176_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	176	0	1	01	01	H0543_176_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	176	0	1	01	01	H0543_176_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				453.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	177	0	1	01	01	H0543_177_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	177	0	1	01	01	H0543_177_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				369.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	178	0	1	01	01	H0543_178_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	178	0	1	01	01	H0543_178_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				297.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	179	0	1	01	01	H0543_179_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	179	0	1	01	01	H0543_179_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				337.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	01	01	H0543_188_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	01	01	H0543_188_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	01	01	H0543_188_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	188	0	1	01	01	H0543_188_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	01	01	H0543_188_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	188	0	1	01	01	H0543_188_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				367.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	01	01	H0543_189_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	01	01	H0543_189_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	01	01	H0543_189_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	189	0	1	01	01	H0543_189_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	01	01	H0543_189_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	189	0	1	01	01	H0543_189_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				358.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	01	01	H0543_191_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	01	01	H0543_191_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	01	01	H0543_191_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	191	0	1	01	01	H0543_191_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	01	01	H0543_191_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	191	0	1	01	01	H0543_191_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				405.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	01	01	H0543_193_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	01	01	H0543_193_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	01	01	H0543_193_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	193	0	1	01	01	H0543_193_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	01	01	H0543_193_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	193	0	1	01	01	H0543_193_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				215.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	194	0	1	01	01	H0543_194_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	194	0	1	01	01	H0543_194_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	194	0	1	01	01	H0543_194_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	194	0	1	01	01	H0543_194_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	194	0	1	01	01	H0543_194_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	194	0	1	01	01	H0543_194_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				426.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	01	01	H0543_195_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	01	01	H0543_195_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	01	01	H0543_195_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	195	0	1	01	01	H0543_195_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	01	01	H0543_195_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	195	0	1	01	01	H0543_195_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				401.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	01	01	H0543_196_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	01	01	H0543_196_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	01	01	H0543_196_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	196	0	1	01	01	H0543_196_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	01	01	H0543_196_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	196	0	1	01	01	H0543_196_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				337.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	01	01	H0543_204_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	01	01	H0543_204_0	4		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	204	0	1	01	01	H0543_204_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	01	01	H0543_204_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	204	0	1	01	01	H0543_204_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	01	01	H0543_204_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	204	0	1	01	01	H0543_204_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											348.00	33						239.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	01	01	H0543_205_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	01	01	H0543_205_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	205	0	1	01	01	H0543_205_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	01	01	H0543_205_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	205	0	1	01	01	H0543_205_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	01	01	H0543_205_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	205	0	1	01	01	H0543_205_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				368.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	01	01	H0543_209_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	01	01	H0543_209_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	209	0	1	01	01	H0543_209_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	01	01	H0543_209_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	209	0	1	01	01	H0543_209_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	01	01	H0543_209_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	209	0	1	01	01	H0543_209_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				368.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	210	0	1	02	01	H0543_210_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	210	0	1	02	01	H0543_210_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	210	0	1	02	01	H0543_210_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				478.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	01	01	H0543_214_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	01	01	H0543_214_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	214	0	1	01	01	H0543_214_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	01	01	H0543_214_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0543	214	0	1	01	01	H0543_214_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	01	01	H0543_214_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	214	0	1	01	01	H0543_214_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				358.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	215	0	1	02	01	H0543_215_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	215	0	1	02	01	H0543_215_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	215	0	1	02	01	H0543_215_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				445.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	216	0	1	02	01	H0543_216_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0543	216	0	1	02	01	H0543_216_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	216	0	1	02	01	H0543_216_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				317.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	002	0	1	01	01	H0544_002_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	9.50	19.00	28.50																			9.50	19.00	19.00																9.50				9.50		0.32			0.32			0.28	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	9.50	19.00	28.50																			9.50	19.00	19.00																9.50				9.50		0.32			0.32			0.28	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	37.50	75.00	112.50																			37.50	75.00	75.00																37.50				37.50		1.25			1.25			1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	5		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				68.83	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				70.02	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		.25			0.25			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	37.50	75.00	112.50																			37.50	75.00	75.00																37.50				37.50		1.25			1.25			1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	9.50	19.00	28.50																			9.50	19.00	19.00																9.50				9.50		0.32			0.32			0.28	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	9.50	19.00	28.50																			9.50	19.00	19.00																9.50				9.50		0.32			0.32			0.28	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	37.50	75.00	112.50																			37.50	75.00	75.00																37.50				37.50		1.25			1.25			1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	007	0	1	01	01	H0544_007_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	14.50	29.00	43.50																			14.50	29.00	29.00																14.50				14.50		0.48			0.48			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	010	0	1	01	01	H0544_010_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	013	0	1	01	01	H0544_013_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		.25			0.25			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	37.50	75.00	112.50																			37.50	75.00	75.00																37.50				37.50		1.25			1.25			1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		.25			0.25			.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	37.50	75.00	112.50																			37.50	75.00	75.00																37.50				37.50		1.25			1.25			1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	37.50	75.00	112.50																			37.50	75.00	75.00																37.50				37.50		1.25			1.25			1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	020	0	1	01	01	H0544_020_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	027	0	1	01	01	H0544_027_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	031	0	1	01	01	H0544_031_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	032	0	1	01	01	H0544_032_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	036	0	1	01	01	H0544_036_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	038	0	1	01	01	H0544_038_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	050	0	1	01	01	H0544_050_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	050	0	1	01	01	H0544_050_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	050	0	1	01	01	H0544_050_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	052	0	1	01	01	H0544_052_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	052	0	1	01	01	H0544_052_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	052	0	1	01	01	H0544_052_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	053	0	1	01	01	H0544_053_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	053	0	1	01	01	H0544_053_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	054	0	1	01	01	H0544_054_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	054	0	1	01	01	H0544_054_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0544	054	0	1	01	01	H0544_054_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00	27.00	27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	054	0	1	01	01	H0544_054_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	054	0	1	01	01	H0544_054_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	054	0	1	01	01	H0544_054_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	054	0	1	01	01	H0544_054_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	054	0	1	01	01	H0544_054_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	055	0	1	01	01	H0544_055_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	055	0	1	01	01	H0544_055_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	055	0	1	01	01	H0544_055_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	056	0	1	01	01	H0544_056_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	056	0	1	01	01	H0544_056_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	057	0	1	01	01	H0544_057_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	057	0	1	01	01	H0544_057_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	057	0	1	01	01	H0544_057_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	16.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	057	0	1	01	01	H0544_057_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	057	0	1	01	01	H0544_057_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	057	0	1	01	01	H0544_057_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	058	0	1	01	01	H0544_058_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					0.00	0.00	0.00																10.00				10.00			0.33	0.17	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	058	0	1	01	01	H0544_058_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	059	0	1	01	01	H0544_059_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	059	0	1	01	01	H0544_059_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	059	0	1	01	01	H0544_059_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					0.00	0.00	0.00																10.00				10.00			0.33	0.17	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	059	0	1	01	01	H0544_059_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	059	0	1	01	01	H0544_059_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	059	0	1	01	01	H0544_059_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	3	1	01	01	H0544_060_3	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	3	1	01	01	H0544_060_3	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	060	3	1	01	01	H0544_060_3	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	3	1	01	01	H0544_060_3	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	3	1	01	01	H0544_060_3	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	3	1	01	01	H0544_060_3	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	4	1	01	01	H0544_060_4	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	4	1	01	01	H0544_060_4	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	060	4	1	01	01	H0544_060_4	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	4	1	01	01	H0544_060_4	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	4	1	01	01	H0544_060_4	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	060	4	1	01	01	H0544_060_4	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	061	0	1	01	01	H0544_061_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	061	0	1	01	01	H0544_061_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	062	0	1	01	01	H0544_062_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	062	0	1	01	01	H0544_062_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	063	0	1	01	01	H0544_063_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					5.00	10.00	15.00					5.00	15.00	15.00																14.00				14.00			0.47	0.17	0.17			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	063	0	1	01	01	H0544_063_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	064	0	1	01	01	H0544_064_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	064	0	1	01	01	H0544_064_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	065	0	1	01	01	H0544_065_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	065	0	1	01	01	H0544_065_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	066	0	1	01	01	H0544_066_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	066	0	1	01	01	H0544_066_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					0.00	0.00	0.00																10.00				10.00			0.33	0.17	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	066	0	1	01	01	H0544_066_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	067	0	1	01	01	H0544_067_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	067	0	1	01	01	H0544_067_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	067	0	1	01	01	H0544_067_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					0.00	0.00	0.00																10.00				10.00			0.33	0.17	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	067	0	1	01	01	H0544_067_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	067	0	1	01	01	H0544_067_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	067	0	1	01	01	H0544_067_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	069	0	1	01	01	H0544_069_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	069	0	1	01	01	H0544_069_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	070	0	1	01	01	H0544_070_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00	27.00	27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	070	0	1	01	01	H0544_070_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	071	0	1	01	01	H0544_071_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00	36.00	36.00																12.00				12.00			0.40	0.40	0.40			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	071	0	1	01	01	H0544_071_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	072	0	1	01	01	H0544_072_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	072	0	1	01	01	H0544_072_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	074	0	1	01	01	H0544_074_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	074	0	1	01	01	H0544_074_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	074	0	1	01	01	H0544_074_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	074	0	1	01	01	H0544_074_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	074	0	1	01	01	H0544_074_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	074	0	1	01	01	H0544_074_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	074	0	1	01	01	H0544_074_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	081	0	1	01	01	H0544_081_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	081	0	1	01	01	H0544_081_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								2.00	4.00	6.00					2.00	4.00	6.00					2.00	6.00	6.00																2.00				2.00			0.07	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	081	0	1	01	01	H0544_081_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	087	0	1	01	01	H0544_087_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	087	0	1	01	01	H0544_087_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	088	0	1	01	01	H0544_088_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	088	0	1	01	01	H0544_088_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	089	0	1	01	01	H0544_089_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	089	0	1	01	01	H0544_089_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	090	0	1	01	01	H0544_090_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	090	0	1	01	01	H0544_090_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	091	0	1	01	01	H0544_091_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	091	0	1	01	01	H0544_091_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	093	0	1	01	01	H0544_093_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	093	0	1	01	01	H0544_093_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	093	0	1	01	01	H0544_093_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	093	0	1	01	01	H0544_093_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	094	0	1	01	01	H0544_094_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	094	0	1	01	01	H0544_094_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	094	0	1	01	01	H0544_094_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	094	0	1	01	01	H0544_094_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	095	0	1	01	01	H0544_095_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	095	0	1	01	01	H0544_095_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	096	0	1	01	01	H0544_096_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	096	0	1	01	01	H0544_096_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	096	0	1	01	01	H0544_096_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	096	0	1	01	01	H0544_096_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	096	0	1	01	01	H0544_096_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	096	0	1	01	01	H0544_096_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	097	0	1	01	01	H0544_097_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	097	0	1	01	01	H0544_097_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	097	0	1	01	01	H0544_097_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	097	0	1	01	01	H0544_097_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	097	0	1	01	01	H0544_097_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	097	0	1	01	01	H0544_097_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0544	098	0	1	01	01	H0544_098_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	098	0	1	01	01	H0544_098_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	099	0	1	01	01	H0544_099_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	099	0	1	01	01	H0544_099_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	100	0	1	01	01	H0544_100_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0544	100	0	1	01	01	H0544_100_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								8.00	16.00	24.00					8.00	16.00	24.00					8.00	24.00	24.00																8.00				8.00			0.27	0.27	0.27			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	100	0	1	01	01	H0544_100_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	101	0	1	01	01	H0544_101_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	101	0	1	01	01	H0544_101_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	101	0	1	01	01	H0544_101_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	101	0	1	01	01	H0544_101_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	102	0	1	01	01	H0544_102_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	102	0	1	01	01	H0544_102_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	102	0	1	01	01	H0544_102_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	102	0	1	01	01	H0544_102_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	103	0	1	01	01	H0544_103_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	103	0	1	01	01	H0544_103_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	103	0	1	01	01	H0544_103_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	103	0	1	01	01	H0544_103_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	104	0	1	01	01	H0544_104_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	104	0	1	01	01	H0544_104_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	104	0	1	01	01	H0544_104_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	104	0	1	01	01	H0544_104_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	105	0	1	01	01	H0544_105_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	105	0	1	01	01	H0544_105_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	105	0	1	01	01	H0544_105_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	105	0	1	01	01	H0544_105_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	106	0	1	01	01	H0544_106_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	106	0	1	01	01	H0544_106_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	106	0	1	01	01	H0544_106_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	106	0	1	01	01	H0544_106_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	107	0	1	01	01	H0544_107_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	107	0	1	01	01	H0544_107_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	107	0	1	01	01	H0544_107_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	107	0	1	01	01	H0544_107_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	108	0	1	01	01	H0544_108_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	108	0	1	01	01	H0544_108_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	108	0	1	01	01	H0544_108_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	108	0	1	01	01	H0544_108_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	108	0	1	01	01	H0544_108_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	108	0	1	01	01	H0544_108_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0544	110	0	1	01	01	H0544_110_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	110	0	1	01	01	H0544_110_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	117	1	1	01	01	H0544_117_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	117	1	1	01	01	H0544_117_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	117	1	1	01	01	H0544_117_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	1	1	01	01	H0544_117_1	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	117	2	1	01	01	H0544_117_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	117	2	1	01	01	H0544_117_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	117	2	1	01	01	H0544_117_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	117	2	1	01	01	H0544_117_2	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	118	1	1	01	01	H0544_118_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	118	1	1	01	01	H0544_118_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	118	1	1	01	01	H0544_118_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	1	1	01	01	H0544_118_1	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	118	2	1	01	01	H0544_118_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	118	2	1	01	01	H0544_118_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	118	2	1	01	01	H0544_118_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	118	2	1	01	01	H0544_118_2	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	119	1	1	01	01	H0544_119_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	119	1	1	01	01	H0544_119_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	119	1	1	01	01	H0544_119_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	1	1	01	01	H0544_119_1	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	119	2	1	01	01	H0544_119_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	119	2	1	01	01	H0544_119_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	119	2	1	01	01	H0544_119_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	119	2	1	01	01	H0544_119_2	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	120	1	1	01	01	H0544_120_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	120	1	1	01	01	H0544_120_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	120	1	1	01	01	H0544_120_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	1	1	01	01	H0544_120_1	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	120	2	1	01	01	H0544_120_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	120	2	1	01	01	H0544_120_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	120	2	1	01	01	H0544_120_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	120	2	1	01	01	H0544_120_2	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H0544	121	1	1	01	01	H0544_121_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.50	35.00	52.50					12.50	25.00	37.50					12.50	25.00	25.00																17.50				17.50			0.58	0.42	0.42			0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	1	1	01	01	H0544_121_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.50	35.00	52.50					12.50	25.00	37.50					12.50	25.00	25.00																17.50				17.50			0.58	0.42	0.42			0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	121	2	1	01	01	H0544_121_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	1	1	01	01	H0544_122_1	6		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				1.33	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	1	1	01	01	H0544_122_1	6		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				5.27	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	1	1	01	01	H0544_122_1	6		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				67.93	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	1	1	01	01	H0544_122_1	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				70.31	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	1	1	01	01	H0544_122_1	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	1	1	01	01	H0544_122_1	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	1	1	01	01	H0544_122_1	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	122	2	1	01	01	H0544_122_2	6		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				1.33	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	2	1	01	01	H0544_122_2	6		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				5.27	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	2	1	01	01	H0544_122_2	6		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				67.93	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	2	1	01	01	H0544_122_2	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				70.31	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	2	1	01	01	H0544_122_2	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	2	1	01	01	H0544_122_2	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	2	1	01	01	H0544_122_2	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	122	3	1	01	01	H0544_122_3	6		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				1.33	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	3	1	01	01	H0544_122_3	6		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				5.27	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	3	1	01	01	H0544_122_3	6		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				67.93	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	3	1	01	01	H0544_122_3	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				70.31	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	3	1	01	01	H0544_122_3	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	3	1	01	01	H0544_122_3	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	122	3	1	01	01	H0544_122_3	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0545	001	0	1	01	01	H0545_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	001	0	1	01	01	H0545_001_0	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H0545	001	0	1	01	01	H0545_001_0	7		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	1			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	001	0	1	01	01	H0545_001_0	7		Y	Generic	4	01	3	2	2	3	110		01	100		1	30		90				2	1			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H0545	001	0	1	01	01	H0545_001_0	7		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	001	0	1	01	01	H0545_001_0	7		Y	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				55.37	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	001	0	1	01	01	H0545_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1173.54	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	001	0	1	01	01	H0545_001_0	7		Y	Select Diabetic Drugs	4	11	1	2	6	1	110		01	100		1	30		90				2	1			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	001	0	1	01	01	H0545_001_0	7		Y	Select Diabetic Drugs	4	11	1	2	6	3	110		01	100		1	30		90				2	1			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H0545	012	0	1	01	01	H0545_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	012	0	1	01	01	H0545_012_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H0545	012	0	1	01	01	H0545_012_0	3		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	1			90				30		31	12.00		36.00																					36.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	012	0	1	01	01	H0545_012_0	3		Y	Generic	4	01	3	2	2	3	110		01	100		1	30		90				2	1			90				30		31	12.00		36.00																					36.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H0545	012	0	1	01	01	H0545_012_0	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	1			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	012	0	1	01	01	H0545_012_0	3		Y	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				71.52	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	012	0	1	01	01	H0545_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				935.69	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	012	0	1	01	01	H0545_012_0	3		Y	Select Diabetic Drugs	4	11	1	2	6	1	110		01	110		1	30		90				2	1	30		90				30		31	11.00		33.00																			11.00		33.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H0545	012	0	1	01	01	H0545_012_0	3		Y	Select Diabetic Drugs	4	11	1	2	6	3	110		01	110		1	30		90				2	1	30		90				30		31	11.00		33.00																			11.00		33.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H0545	015	0	1	01	01	H0545_015_0	5		N	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	015	0	1	01	01	H0545_015_0	5		N	Generic	2	01	1	1	2	1	110		01	100		1	30		90				2	1			90				30		31				7.30	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	015	0	1	01	01	H0545_015_0	5		N	Preferred Brand	2	10	1	1	3	1	110		01	100		1	30		90				2	1			90				30		31				110.91	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	015	0	1	01	01	H0545_015_0	5		N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	1			90				30		31				139.80	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0545	015	0	1	01	01	H0545_015_0	5		N	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31				732.31	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	009	0	1	01	01	H0562_009_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					5.00	10.00	15.00					5.00	10.00	10.00																18.00				18.00			0.60	0.17	0.17			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					10.00	20.00	30.00					10.00	20.00	20.00																19.00				19.00			0.63	0.33	0.33			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	055	0	1	01	01	H0562_055_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	055	0	1	01	01	H0562_055_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	055	0	1	01	01	H0562_055_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				77.00	41	41	41																		41	41	41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	055	0	1	01	01	H0562_055_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	068	0	1	01	01	H0562_068_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					13.00	26.00	39.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					13.00	26.00	39.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					11.00	22.00	33.00					11.00	22.00	22.00																18.00				18.00			0.60	0.37	0.37			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	6.00																20.00				20.00			0.67	0.10	0.10			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	092	0	1	01	01	H0562_092_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	097	0	1	01	01	H0562_097_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00					0.00	0.00	0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					3.00	6.00	9.00					3.00	6.00	6.00																15.00				15.00			0.50	0.10	0.10			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					0.00	0.00	0.00					0.00	0.00	0.00																13.00				13.00			0.43	0.00	0.00			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	6.00																20.00				20.00			0.67	0.10	0.10			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	6.00																20.00				20.00			0.67	0.10	0.10			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					35.00	70.00	105.00					35.00	70.00	95.00																47.00				47.00			1.57	1.17	1.17			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					75.00	150.00	225.00					75.00	150.00	215.00																100.00				100.00			3.33	2.50	2.50			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00					0.00	0.00	0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					5.00	10.00	15.00					5.00	10.00	10.00																15.00				15.00			0.50	0.17	0.17			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	114	0	1	01	01	H0562_114_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					0.00	0.00	0.00					0.00	0.00	0.00																20.00				20.00			0.67	0.00	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					10.00	20.00	30.00					10.00	20.00	20.00																47.00				47.00			1.57	0.33	0.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					75.00	150.00	225.00					75.00	150.00	215.00																100.00				100.00			3.33	2.50	2.50			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	118	0	1	01	01	H0562_118_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	119	0	1	01	01	H0562_119_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					3.00	6.00	9.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	119	0	1	01	01	H0562_119_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				20.00			0.67	0.27	0.27			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	119	0	1	01	01	H0562_119_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	119	0	1	01	01	H0562_119_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	119	0	1	01	01	H0562_119_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	119	0	1	01	01	H0562_119_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				20.00			0.67	0.27	0.27			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	120	0	1	01	01	H0562_120_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	121	0	1	01	01	H0562_121_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	121	0	1	01	01	H0562_121_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	121	0	1	01	01	H0562_121_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	121	0	1	01	01	H0562_121_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				94.00	46	46	46																		46	46	46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	121	0	1	01	01	H0562_121_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0562	122	0	1	01	01	H0562_122_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.00	46	46	46																		46	46	46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	122	0	1	01	01	H0562_122_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	2.00																3.00				3.00			0.10	0.03	0.03			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	9.00					1.00	2.00	3.00					1.00	2.00	2.00																3.00				3.00			0.10	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	123	0	1	01	01	H0562_123_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				20.00			0.67	0.27	0.27			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	123	0	1	01	01	H0562_123_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	124	0	1	01	01	H0562_124_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				20.00			0.67	0.27	0.27			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	124	0	1	01	01	H0562_124_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0562	125	0	1	01	01	H0562_125_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	2.00																5.00				5.00			0.17	0.03	0.03			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	2.00																5.00				5.00			0.17	0.03	0.03			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	125	0	1	01	01	H0562_125_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	33						0.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	125	0	1	01	01	H0562_125_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	126	0	1	01	01	H0562_126_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H0562	126	0	1	01	01	H0562_126_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	2.00																5.00				5.00			0.17	0.03	0.03			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					1.00	2.00	3.00					1.00	2.00	2.00																5.00				5.00			0.17	0.03	0.03			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0562	126	0	1	01	01	H0562_126_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0562	126	0	1	01	01	H0562_126_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0571	001	0	1	01	01	H0571_001_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	10	100		1				30	60	90	1	2			90					14	31								3.00	6.00	9.00					3.00	6.00	6.00							6.00																	3.00			3.00			0.10	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	11		Y	Generic	4	01	1	2	2	1		111	10	100		1				30	60	90	1	2			90					14	31								7.00	14.00	21.00					7.00	14.00	14.00							14.00																	7.00			7.00			0.23	0.23				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	10	100		1				30	60	90	1	2			90					14	31								40.00	80.00	120.00					40.00	80.00	80.00							80.00																	40.00			40.00			1.33	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	11		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	100		1				30	60	90	1	2			90					14	31								60.00	120.00	180.00					60.00	120.00	120.00							120.00																	60.00			60.00			2.00	2.00				1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							14	31											983.94	33						983.94	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	10	100		1				30	60	90	1	2			90					14	31								5.00	10.00	15.00					5.00	10.00	10.00							10.00																	5.00			5.00			0.17	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	11		Y	Generic	4	01	1	2	2	1		111	10	100		1				30	60	90	1	2			90					14	31								12.00	24.00	36.00					12.00	24.00	24.00							24.00																	12.00			12.00			0.40	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	10	100		1				30	60	90	1	2			90					14	31								47.00	94.00	141.00					47.00	94.00	94.00							94.00																	47.00			47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	11		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	100		1				30	60	90	1	2			90					14	31								100.00	200.00	300.00					100.00	200.00	200.00							200.00																	100.00			100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	007	0	1	01	01	H0571_007_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							14	31											973.53	31						973.53	31						31																		31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	007	0	1	01	01	H0609_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				410.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	012	0	1	01	01	H0609_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				483.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	025	0	1	01	01	H0609_025_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				313.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	026	0	1	01	01	H0609_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				204.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	027	0	1	01	01	H0609_027_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				465.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	028	0	1	01	01	H0609_028_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	028	0	1	01	01	H0609_028_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				398.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	01	01	H0609_031_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	01	01	H0609_031_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	031	0	1	01	01	H0609_031_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	01	01	H0609_031_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	031	0	1	01	01	H0609_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	01	01	H0609_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	031	0	1	01	01	H0609_031_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	032	0	1	01	01	H0609_032_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	032	0	1	01	01	H0609_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	032	0	1	01	01	H0609_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				356.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	01	01	H0609_033_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	01	01	H0609_033_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	033	0	1	01	01	H0609_033_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	01	01	H0609_033_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	033	0	1	01	01	H0609_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	01	01	H0609_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	033	0	1	01	01	H0609_033_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				278.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	01	01	H0609_034_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	01	01	H0609_034_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	01	01	H0609_034_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	034	1	1	01	01	H0609_034_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	01	01	H0609_034_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	1	1	01	01	H0609_034_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				228.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	01	01	H0609_034_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	01	01	H0609_034_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	01	01	H0609_034_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	034	2	1	01	01	H0609_034_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	01	01	H0609_034_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	034	2	1	01	01	H0609_034_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				228.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	01	01	H0609_036_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	01	01	H0609_036_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	01	01	H0609_036_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	036	1	1	01	01	H0609_036_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	01	01	H0609_036_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	1	1	01	01	H0609_036_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				280.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	01	01	H0609_036_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	01	01	H0609_036_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	01	01	H0609_036_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	036	2	1	01	01	H0609_036_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	01	01	H0609_036_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	036	2	1	01	01	H0609_036_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				280.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	01	01	H0609_037_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	01	01	H0609_037_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	037	0	1	01	01	H0609_037_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	01	01	H0609_037_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	037	0	1	01	01	H0609_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	01	01	H0609_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	037	0	1	01	01	H0609_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				359.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	01	01	H0609_038_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	01	01	H0609_038_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	038	0	1	01	01	H0609_038_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	01	01	H0609_038_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0609	038	0	1	01	01	H0609_038_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	01	01	H0609_038_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	038	0	1	01	01	H0609_038_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											507.00	33						318.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	01	01	H0609_040_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	01	01	H0609_040_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	040	0	1	01	01	H0609_040_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	01	01	H0609_040_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0609	040	0	1	01	01	H0609_040_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	01	01	H0609_040_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	040	0	1	01	01	H0609_040_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				260.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0628	001	0	1	01	01	H0628_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	001	0	1	01	01	H0628_001_0	7		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	001	0	1	01	01	H0628_001_0	7		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	001	0	1	01	01	H0628_001_0	7		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	001	0	1	01	01	H0628_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	001	0	1	01	01	H0628_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	001	0	1	01	01	H0628_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											716.30	33						525.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	003	0	1	01	01	H0628_003_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	003	0	1	01	01	H0628_003_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	003	0	1	01	01	H0628_003_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	003	0	1	01	01	H0628_003_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	003	0	1	01	01	H0628_003_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	003	0	1	01	01	H0628_003_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	003	0	1	01	01	H0628_003_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											763.62	33						558.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	005	0	1	01	01	H0628_005_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	005	0	1	01	01	H0628_005_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	005	0	1	01	01	H0628_005_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	005	0	1	01	01	H0628_005_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	005	0	1	01	01	H0628_005_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	005	0	1	01	01	H0628_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	005	0	1	01	01	H0628_005_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											758.13	33						555.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	006	0	1	01	01	H0628_006_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	006	0	1	01	01	H0628_006_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	006	0	1	01	01	H0628_006_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	006	0	1	01	01	H0628_006_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	006	0	1	01	01	H0628_006_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	006	0	1	01	01	H0628_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	006	0	1	01	01	H0628_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											710.10	33						521.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	007	0	1	01	01	H0628_007_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	007	0	1	01	01	H0628_007_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	007	0	1	01	01	H0628_007_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	007	0	1	01	01	H0628_007_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	007	0	1	01	01	H0628_007_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	007	0	1	01	01	H0628_007_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	007	0	1	01	01	H0628_007_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											682.65	33						503.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	008	0	1	01	01	H0628_008_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	008	0	1	01	01	H0628_008_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	008	0	1	01	01	H0628_008_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	008	0	1	01	01	H0628_008_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	008	0	1	01	01	H0628_008_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	008	0	1	01	01	H0628_008_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	008	0	1	01	01	H0628_008_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											709.98	33						521.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	009	0	1	01	01	H0628_009_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	009	0	1	01	01	H0628_009_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	009	0	1	01	01	H0628_009_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	009	0	1	01	01	H0628_009_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	009	0	1	01	01	H0628_009_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	009	0	1	01	01	H0628_009_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	009	0	1	01	01	H0628_009_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											699.55	33						514.11	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	010	0	1	01	01	H0628_010_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	010	0	1	01	01	H0628_010_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	010	0	1	01	01	H0628_010_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	010	0	1	01	01	H0628_010_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	010	0	1	01	01	H0628_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	010	0	1	01	01	H0628_010_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	010	0	1	01	01	H0628_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											689.81	33						507.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	011	0	1	01	01	H0628_011_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	011	0	1	01	01	H0628_011_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	011	0	1	01	01	H0628_011_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	011	0	1	01	01	H0628_011_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	011	0	1	01	01	H0628_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	011	0	1	01	01	H0628_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	011	0	1	01	01	H0628_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											712.37	33						522.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	012	0	1	01	01	H0628_012_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	012	0	1	01	01	H0628_012_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	012	0	1	01	01	H0628_012_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.83	25	25	25				29.51	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	012	0	1	01	01	H0628_012_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.25	35	35	35				49.01	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	012	0	1	01	01	H0628_012_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											483.26	29						379.11	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	013	0	1	01	01	H0628_013_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	013	0	1	01	01	H0628_013_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	013	0	1	01	01	H0628_013_0	3		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.86	25	25	25				29.57	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	013	0	1	01	01	H0628_013_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.31	35	35	35				49.08	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	013	0	1	01	01	H0628_013_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											494.17	29						386.12	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	017	0	1	01	01	H0628_017_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	017	0	1	01	01	H0628_017_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	017	0	1	01	01	H0628_017_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	017	0	1	01	01	H0628_017_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0628	017	0	1	01	01	H0628_017_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	017	0	1	01	01	H0628_017_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0628	017	0	1	01	01	H0628_017_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											745.05	33						544.56	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H0630	013	0	1	01	01	H0630_013_0	10		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					2.00	4.00	6.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.06		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.33		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	245.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											738.00	31	31	31				738.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					2.00	4.00	6.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.06		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.33		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	245.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											703.00	31	31	31				703.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	9		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.26		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	245.00				100.00				100.00			3.33	3.00		3.33	3.00	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											869.00	31	31	31				869.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	9		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					2.00	4.00	6.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.06		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	9		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.33		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	9		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	245.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											807.00	31	31	31				807.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	9		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					2.00	4.00	6.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.06		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.33		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	245.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											996.00	31	31	31				996.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	9		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.33		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	245.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											624.00	31	31	31				624.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	9		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	01	01	H0630_023_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					2.00	4.00	6.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.06		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	01	01	H0630_023_0	9		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.66	0.33		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	01	01	H0630_023_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	100.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	01	01	H0630_023_0	9		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	245.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	01	01	H0630_023_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											742.00	31	31	31				742.00	31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	023	0	1	01	01	H0630_023_0	9		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0672	001	0	1	01	01	H0672_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	001	0	1	01	01	H0672_001_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	001	0	1	01	01	H0672_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	001	0	1	01	01	H0672_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	001	0	1	01	01	H0672_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	002	0	1	01	01	H0672_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	002	0	1	01	01	H0672_002_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	002	0	1	01	01	H0672_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	002	0	1	01	01	H0672_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	002	0	1	01	01	H0672_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	003	0	1	01	01	H0672_003_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	003	0	1	01	01	H0672_003_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	003	0	1	01	01	H0672_003_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	003	0	1	01	01	H0672_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	003	0	1	01	01	H0672_003_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	004	0	1	01	01	H0672_004_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	004	0	1	01	01	H0672_004_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	004	0	1	01	01	H0672_004_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	004	0	1	01	01	H0672_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	004	0	1	01	01	H0672_004_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	005	0	1	01	01	H0672_005_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	005	0	1	01	01	H0672_005_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.17		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	005	0	1	01	01	H0672_005_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	005	0	1	01	01	H0672_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	005	0	1	01	01	H0672_005_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0672	006	0	1	01	01	H0672_006_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0672	006	0	1	01	01	H0672_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											855.67	33						711.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	008	0	1	04	01	H0710_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				304.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	009	0	1	04	01	H0710_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				283.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	012	0	1	04	01	H0710_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				295.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	030	0	1	04	01	H0710_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				259.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	037	0	1	04	01	H0710_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	037	0	1	04	01	H0710_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				282.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	042	0	1	04	01	H0710_042_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	042	0	1	04	01	H0710_042_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	042	0	1	04	01	H0710_042_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	042	0	1	04	01	H0710_042_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	042	0	1	04	01	H0710_042_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	042	0	1	04	01	H0710_042_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				248.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	047	0	1	04	01	H0710_047_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	047	0	1	04	01	H0710_047_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				250.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	049	0	1	04	01	H0710_049_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	049	0	1	04	01	H0710_049_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	049	0	1	04	01	H0710_049_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	049	0	1	04	01	H0710_049_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	049	0	1	04	01	H0710_049_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	049	0	1	04	01	H0710_049_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				253.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0710	050	0	1	04	01	H0710_050_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	050	0	1	04	01	H0710_050_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				245.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.43	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H0712	019	0	1	01	01	H0712_019_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.2				0.2	0.2	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.95	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.71	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	022	0	1	01	01	H0712_022_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	022	0	1	01	01	H0712_022_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	022	0	1	01	01	H0712_022_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	022	0	1	01	01	H0712_022_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				76.71	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	022	0	1	01	01	H0712_022_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	023	0	1	01	01	H0712_023_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	023	0	1	01	01	H0712_023_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	023	0	1	01	01	H0712_023_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	023	0	1	01	01	H0712_023_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.45	43		43																								43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	023	0	1	01	01	H0712_023_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	025	0	1	01	01	H0712_025_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	025	0	1	01	01	H0712_025_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.2				0.2	0.2	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	025	0	1	01	01	H0712_025_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	025	0	1	01	01	H0712_025_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.18	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	025	0	1	01	01	H0712_025_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	029	0	1	01	01	H0712_029_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	029	0	1	01	01	H0712_029_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.2				0.2	0.2	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	029	0	1	01	01	H0712_029_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	029	0	1	01	01	H0712_029_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.65	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	029	0	1	01	01	H0712_029_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0724	001	0	1	01	01	H0724_001_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	31						0.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	001	0	1	01	01	H0724_001_0	3		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0724	006	0	1	01	01	H0724_006_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0724	006	0	1	01	01	H0724_006_0	3		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0724	006	0	1	01	01	H0724_006_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0724	006	0	1	01	01	H0724_006_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0724	006	0	1	01	01	H0724_006_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0724	006	0	1	01	01	H0724_006_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0724	007	0	1	01	01	H0724_007_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	31						0.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0724	007	0	1	01	01	H0724_007_0	4		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0755	030	0	1	01	01	H0755_030_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	030	0	1	01	01	H0755_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				293.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	031	0	1	01	01	H0755_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				271.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	033	0	1	01	01	H0755_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				332.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	038	0	1	01	01	H0755_038_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				255.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	1	1	01	01	H0755_040_1	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	1	1	01	01	H0755_040_1	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	1	1	01	01	H0755_040_1	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	040	1	1	01	01	H0755_040_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	1	1	01	01	H0755_040_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	1	1	01	01	H0755_040_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				172.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	2	1	01	01	H0755_040_2	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	2	1	01	01	H0755_040_2	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	2	1	01	01	H0755_040_2	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	040	2	1	01	01	H0755_040_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	2	1	01	01	H0755_040_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	040	2	1	01	01	H0755_040_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				172.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	1	1	01	01	H0755_041_1	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	1	1	01	01	H0755_041_1	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	1	1	01	01	H0755_041_1	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	041	1	1	01	01	H0755_041_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	1	1	01	01	H0755_041_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	1	1	01	01	H0755_041_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				278.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	2	1	01	01	H0755_041_2	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	2	1	01	01	H0755_041_2	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	2	1	01	01	H0755_041_2	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	041	2	1	01	01	H0755_041_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	2	1	01	01	H0755_041_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	041	2	1	01	01	H0755_041_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				278.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	1	1	01	01	H0755_042_1	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	1	1	01	01	H0755_042_1	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	1	1	01	01	H0755_042_1	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	042	1	1	01	01	H0755_042_1	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	1	1	01	01	H0755_042_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	1	1	01	01	H0755_042_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				257.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	2	1	01	01	H0755_042_2	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	2	1	01	01	H0755_042_2	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	2	1	01	01	H0755_042_2	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H0755	042	2	1	01	01	H0755_042_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	2	1	01	01	H0755_042_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	042	2	1	01	01	H0755_042_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				257.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	001	0	1	01	01	H0783_001_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	001	0	1	01	01	H0783_001_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	001	0	1	01	01	H0783_001_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	001	0	1	01	01	H0783_001_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0783	001	0	1	01	01	H0783_001_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	4		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	4		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					14.00		42.00							0.00																20.00				14.00			0.67	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											88.36	50		50				75.93	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0798	001	0	1	01	01	H0798_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0838	020	0	1	01	01	H0838_020_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	020	0	1	01	01	H0838_020_0	7		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				7.34	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	020	0	1	01	01	H0838_020_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				99.89	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	020	0	1	01	01	H0838_020_0	7		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				39.56	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	020	0	1	01	01	H0838_020_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	020	0	1	01	01	H0838_020_0	7		N	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	024	0	1	01	01	H0838_024_0	8		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	024	0	1	01	01	H0838_024_0	8		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				7.15	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	024	0	1	01	01	H0838_024_0	8		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				94.02	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	024	0	1	01	01	H0838_024_0	8		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				50.62	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	024	0	1	01	01	H0838_024_0	8		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	024	0	1	01	01	H0838_024_0	8		N	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	7		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	7		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	7		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	7		N	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	7		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	025	0	1	01	01	H0838_025_0	7		N	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	7		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	7		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	7		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	7		N	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	7		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	028	0	1	01	01	H0838_028_0	7		N	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	029	0	1	01	01	H0838_029_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	029	0	1	01	01	H0838_029_0	7		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				7.64	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	029	0	1	01	01	H0838_029_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				87.50	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	029	0	1	01	01	H0838_029_0	7		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				42.75	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	029	0	1	01	01	H0838_029_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	029	0	1	01	01	H0838_029_0	7		N	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	7		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0838	032	0	1	01	01	H0838_032_0	7		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	7		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	7		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	7		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0838	032	0	1	01	01	H0838_032_0	7		N	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0838	033	0	1	01	01	H0838_033_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	033	0	1	01	01	H0838_033_0	7		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				7.94	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	033	0	1	01	01	H0838_033_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				99.10	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	033	0	1	01	01	H0838_033_0	7		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				42.70	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	033	0	1	01	01	H0838_033_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	033	0	1	01	01	H0838_033_0	7		N	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	7		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	037	0	1	01	01	H0838_037_0	7		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	7		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	7		N	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	7		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	037	0	1	01	01	H0838_037_0	7		N	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	1	1	01	01	H0838_039_1	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	1	1	01	01	H0838_039_1	7		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7		Y	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7		Y	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	1	1	01	01	H0838_039_1	7		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	2	1	01	01	H0838_039_2	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	039	2	1	01	01	H0838_039_2	7		Y	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	7		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	7		Y	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	7		Y	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	7		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	039	2	1	01	01	H0838_039_2	7		Y	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	040	1	1	01	01	H0838_040_1	8		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	8		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				6.10	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	8		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				106.43	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	8		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				50.72	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	8		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	1	1	01	01	H0838_040_1	8		N	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	8		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	8		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				6.10	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	8		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				106.43	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	8		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				50.72	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	8		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	040	2	1	01	01	H0838_040_2	8		N	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	8		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	8		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	042	0	1	01	01	H0838_042_0	8		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	8		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	8		N	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	8		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	8		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	042	0	1	01	01	H0838_042_0	8		N	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	043	0	1	01	01	H0838_043_0	8		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	043	0	1	01	01	H0838_043_0	8		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	043	0	1	01	01	H0838_043_0	8		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	043	0	1	01	01	H0838_043_0	8		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	043	0	1	01	01	H0838_043_0	8		N	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	043	0	1	01	01	H0838_043_0	8		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	043	0	1	01	01	H0838_043_0	8		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	043	0	1	01	01	H0838_043_0	8		N	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0838	044	0	1	01	01	H0838_044_0	9		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	9		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				3.41	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	9		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				33.91	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	9		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				17.25	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	9		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	044	0	1	01	01	H0838_044_0	9		N	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	045	0	1	01	01	H0838_045_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	045	0	1	01	01	H0838_045_0	7		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				3.41	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	045	0	1	01	01	H0838_045_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				33.91	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	045	0	1	01	01	H0838_045_0	7		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				17.25	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	045	0	1	01	01	H0838_045_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0838	045	0	1	01	01	H0838_045_0	7		N	Select Care Drugs	4	10	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0885	001	0	1	04	01	H0885_001_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	001	0	1	04	01	H0885_001_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			5.00	10.00	15.00																10.00				10.00		0.33			0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	001	0	1	04	01	H0885_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	001	0	1	04	01	H0885_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	001	0	1	04	01	H0885_001_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				758.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	002	0	1	04	01	H0885_002_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	002	0	1	04	01	H0885_002_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			5.00	10.00	15.00																10.00				10.00		0.33			0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	002	0	1	04	01	H0885_002_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	002	0	1	04	01	H0885_002_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0885	002	0	1	04	01	H0885_002_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				752.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0907	001	0	1	01	01	H0907_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0907	001	0	1	01	01	H0907_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0907	001	0	1	01	01	H0907_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0907	001	0	1	01	01	H0907_001_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0908	001	0	1	01	01	H0908_001_0	2		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0908	001	0	1	01	01	H0908_001_0	2		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0908	001	0	1	01	01	H0908_001_0	2		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0908	001	0	1	01	01	H0908_001_0	2		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0908	001	0	1	01	01	H0908_001_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				91.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0908	001	0	1	01	01	H0908_001_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	02	01	H0913_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	02	01	H0913_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	02	01	H0913_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	02	01	H0913_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.53	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	02	01	H0913_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	43.00		129.00																									43.00		129.00				43.00		86.00				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.75	43		43																								43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	015	0	1	01	01	H0913_015_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	015	0	1	01	01	H0913_015_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	015	0	1	01	01	H0913_015_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	015	0	1	01	01	H0913_015_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.66	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	015	0	1	01	01	H0913_015_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	017	0	1	01	01	H0913_017_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	017	0	1	01	01	H0913_017_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	017	0	1	01	01	H0913_017_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	017	0	1	01	01	H0913_017_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.94	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	017	0	1	01	01	H0913_017_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0927	001	0	1	48	05	H0927_001_0	3			Generic Drugs	4	11			1	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0927	001	0	1	48	05	H0927_001_0	3			Brand Drugs	4	11			2	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0927	001	0	1	48	05	H0927_001_0	3			Non-Medicare OTC Drugs	4	11			3	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0969	001	0	1	04	01	H0969_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	001	0	1	04	01	H0969_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	001	0	1	04	01	H0969_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	001	0	1	04	01	H0969_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.33	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	001	0	1	04	01	H0969_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	002	0	1	04	01	H0969_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	002	0	1	04	01	H0969_002_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H0969	002	0	1	04	01	H0969_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	002	0	1	04	01	H0969_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	002	0	1	04	01	H0969_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.78	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0969	002	0	1	04	01	H0969_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0982	001	0	1	01	01	H0982_001_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	001	0	1	01	01	H0982_001_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	6		N	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	001	0	1	01	01	H0982_001_0	6		N	Preferred Brand	4	10	1	2	3	1	110		01			1	30		90				2	2							30		31	0.00		0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	35.00		90.00																																					35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	6		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1708.87	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	001	0	1	01	01	H0982_001_0	6		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	7		N	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	002	0	1	01	01	H0982_002_0	7		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	7		N	Generic	4	01	1	1	2	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	002	0	1	01	01	H0982_002_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31				0.00	0		0																																			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	7		N	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31				123.47	25		25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				827.79	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	002	0	1	01	01	H0982_002_0	7		N	Supplemental Drugs	4	11	2	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	005	0	1	01	01	H0982_005_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	6		N	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	005	0	1	01	01	H0982_005_0	6		N	Preferred Brand	4	10	1	2	3	1	110		01			1	30		90				2	2							30		31	25.00		60.00																																					25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	85.00		235.00																																					85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	6		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1693.64	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	005	0	1	01	01	H0982_005_0	6		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	7		N	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	006	0	1	01	01	H0982_006_0	7		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	7		N	Generic	4	01	1	1	2	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	006	0	1	01	01	H0982_006_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31				0.00	0		0																																			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	7		N	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31				139.99	25		25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				886.52	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	006	0	1	01	01	H0982_006_0	7		N	Supplemental Drugs	4	11	2	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	007	0	1	01	01	H0982_007_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	6		N	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	007	0	1	01	01	H0982_007_0	6		N	Preferred Brand	4	10	1	2	3	1	110		01			1	30		90				2	2							30		31	20.00		50.00																																					20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	85.00		235.00																																					85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	6		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1692.80	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	007	0	1	01	01	H0982_007_0	6		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	008	0	1	01	01	H0982_008_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	6		N	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	008	0	1	01	01	H0982_008_0	6		N	Preferred Brand	4	10	1	2	3	1	110		01			1	30		90				2	2							30		31	20.00		50.00																																					20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	97.00		291.00																																					97.00				97.00		3.23						3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	6		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1698.03	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	008	0	1	01	01	H0982_008_0	6		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	009	0	1	01	01	H0982_009_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	6		N	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	009	0	1	01	01	H0982_009_0	6		N	Preferred Brand	4	10	1	2	3	1	110		01			1	30		90				2	2							30		31	25.00		60.00																																					25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01			1	30		90				2	2							30		31	85.00		235.00																																					85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	6		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1691.26	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	009	0	1	01	01	H0982_009_0	6		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	7		N	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	010	0	1	01	01	H0982_010_0	7		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	7		N	Generic	4	01	1	1	2	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	010	0	1	01	01	H0982_010_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31				0.00	0		0																																			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	7		N	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31				139.61	25		25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				886.35	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	010	0	1	01	01	H0982_010_0	7		N	Supplemental Drugs	4	11	2	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7		N	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	011	0	1	01	01	H0982_011_0	7		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7		N	Generic	4	01	1	1	2	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	011	0	1	01	01	H0982_011_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31				0.00	0		0																																			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7		N	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31				140.75	25		25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				886.87	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	011	0	1	01	01	H0982_011_0	7		N	Supplemental Drugs	4	11	2	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	7		N	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	012	0	1	01	01	H0982_012_0	7		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	7		N	Generic	4	01	1	1	2	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	012	0	1	01	01	H0982_012_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31				0.00	0		0																																			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	7		N	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31				141.61	25		25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				887.24	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	012	0	1	01	01	H0982_012_0	7		N	Supplemental Drugs	4	11	2	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	7		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	7		N	Preferred Generic	4	01	1	1	1	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	013	0	1	01	01	H0982_013_0	7		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	7		N	Generic	4	01	1	1	2	3	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H0982	013	0	1	01	01	H0982_013_0	7		N	Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				2	2							30		31				0.00	0		0																																			0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	7		N	Non-Preferred Brand	4	10	1	1	4	1	110		01			1	30		90				2	2							30		31				136.30	25		25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	7		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				885.10	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H0982	013	0	1	01	01	H0982_013_0	7		N	Supplemental Drugs	4	11	2	1	6	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H1016	001	0	1	01	01	H1016_001_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	001	0	1	01	01	H1016_001_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	001	0	1	01	01	H1016_001_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								35.00	70.00	87.50					25.00	50.00	62.50											35.00	70.00	105.00				25.00	50.00	62.50				35.00				25.00			1.17	0.83		1.17	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								85.00	170.00	212.50					70.00	140.00	175.00											85.00	170.00	255.00				70.00	140.00	175.00				85.00				70.00			2.83	2.33		2.83	2.33	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	021	0	1	01	01	H1016_021_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	021	0	1	01	01	H1016_021_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					30.00	60.00	75.00											40.00	80.00	120.00				30.00	60.00	75.00				40.00				30.00			1.33	1.00		1.33	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					75.00	150.00	187.50											100.00	200.00	300.00				75.00	150.00	187.50				100.00				75.00			3.33	2.50		3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	023	0	1	01	01	H1016_023_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				0.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	023	0	1	01	01	H1016_023_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								25.00	50.00	62.50					0.00	0.00	0.00											25.00	50.00	75.00				0.00	0.00	0.00				25.00				0.00			0.83	0.00		0.83	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								85.00	170.00	212.50					65.00	130.00	162.50											85.00	170.00	255.00				65.00	130.00	162.50				85.00				65.00			2.83	2.17		2.83	2.17	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	023	0	1	01	01	H1016_023_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	024	0	1	01	01	H1016_024_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	024	0	1	01	01	H1016_024_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								30.00	60.00	75.00					20.00	40.00	50.00											30.00	60.00	90.00				20.00	40.00	50.00				30.00				20.00			1.00	0.67		1.00	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					75.00	150.00	187.50											100.00	200.00	300.00				75.00	150.00	187.50				100.00				75.00			3.33	2.50		3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	024	0	1	01	01	H1016_024_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	025	0	1	02	01	H1016_025_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				0.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	025	0	1	02	01	H1016_025_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					30.00	60.00	75.00											40.00	80.00	120.00				30.00	60.00	75.00				40.00				30.00			1.33	1.00		1.33	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					75.00	150.00	187.50											100.00	200.00	300.00				75.00	150.00	187.50				100.00				75.00			3.33	2.50		3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	025	0	1	02	01	H1016_025_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	026	0	1	02	01	H1016_026_0	4		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	25.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				0.00				0.00			0.33	0.00		0.33	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	026	0	1	02	01	H1016_026_0	4		Y	Preferred Brand	4	11	3	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								40.00	80.00	100.00					30.00	60.00	75.00											40.00	80.00	120.00				30.00	60.00	75.00				40.00				30.00			1.33	1.00		1.33	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Non-Preferred Drug	4	11	3	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	250.00					75.00	150.00	187.50											100.00	200.00	300.00				75.00	150.00	187.50				100.00				75.00			3.33	2.50		3.33	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	026	0	1	02	01	H1016_026_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4		N	Preferred Generic	4	11	3	2	1	1		111	01		100	1				30	60	100	1	2						100	30		31								5.00	10.00	12.50					0.00	0.00	0.00													15.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4		N	Preferred Generic	4	11	3	2	1	3		111	01		100	1				30	60	100	1	2						100	30		31								5.00	10.00	12.50					0.00	0.00	0.00													15.00						0.00				5.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	028	0	1	01	01	H1016_028_0	4		N	Generic	4	11	3	2	2	1		111	01		100	1				30	60	100	1	2						100	30		31								20.00	40.00	50.00					0.00	0.00	0.00													60.00						0.00				20.00				0.00			0.67	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4		N	Generic	4	11	3	2	2	3		111	01		100	1				30	60	100	1	2						100	30		31								20.00	40.00	50.00					0.00	0.00	0.00													60.00						0.00				20.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	028	0	1	01	01	H1016_028_0	4		N	Preferred Brand	4	11	3	2	3	1		111	01		100	1				30	60	100	1	2						100	30		31								47.00	94.00	118.00					40.00	80.00	100.00													141.00						100.00				47.00				40.00			1.57	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4		N	Non-Preferred Drug	4	11	3	2	4	1		111	01		100	1				30	60	100	1	2						100	30		31								100.00	200.00	250.00					80.00	160.00	200.00													300.00						200.00				100.00				80.00			3.33	2.67				2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	028	0	1	01	01	H1016_028_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											696.39	33						696.39	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	001	0	1	01	01	H1019_001_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	001	0	1	01	01	H1019_001_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					75.00		225.00											100.00		300.00				75.00		215.00				100.00				100.00			3.33	2.50		3.33	2.50	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	006	0	1	01	01	H1019_006_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	006	0	1	01	01	H1019_006_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								36.00		108.00					25.00		75.00											36.00		108.00				25.00		65.00				36.00				36.00			1.20	0.83		1.20	0.83	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					25.00		75.00											47.00		141.00				25.00		65.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					75.00		225.00											100.00		300.00				75.00		215.00				100.00				100.00			3.33	2.50		3.33	2.50	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	5		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	057	0	1	02	01	H1019_057_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	5		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	057	0	1	02	01	H1019_057_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					25.00		75.00											47.00		141.00				25.00		65.00				47.00				47.00			1.57	0.83		1.57	0.83	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	02	01	H1019_057_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					0.00		0.00											12.00		36.00				0.00		0.00				12.00				12.00			0.40	0		0.40	0	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	069	0	1	01	01	H1019_069_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	069	0	1	01	01	H1019_069_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	5		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	089	0	1	01	01	H1019_089_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	5		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	089	0	1	01	01	H1019_089_0	5		Y	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	24		24				43.00	23		23										24		24				23		23			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	24		24				42.00	24		24										24		24				24		24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	089	0	1	01	01	H1019_089_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	092	0	1	01	01	H1019_092_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	092	0	1	01	01	H1019_092_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	092	0	1	01	01	H1019_092_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	092	0	1	01	01	H1019_092_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	092	0	1	01	01	H1019_092_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	094	0	1	01	01	H1019_094_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	098	0	1	01	01	H1019_098_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	098	0	1	01	01	H1019_098_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		80.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	098	0	1	01	01	H1019_098_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		90.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	099	0	1	01	01	H1019_099_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	102	0	1	01	01	H1019_102_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	102	0	1	01	01	H1019_102_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					20.00		60.00											47.00		141.00				20.00		40.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	102	0	1	01	01	H1019_102_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	103	1	1	01	01	H1019_103_1	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	103	1	1	01	01	H1019_103_1	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					55.00		165.00											100.00		300.00				55.00		155.00				100.00				100.00			3.33	1.83		3.33	1.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	1	1	01	01	H1019_103_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	5		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	103	2	1	01	01	H1019_103_2	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	5		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	103	2	1	01	01	H1019_103_2	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					55.00		165.00											100.00		300.00				55.00		155.00				100.00				100.00			3.33	1.83		3.33	1.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	103	2	1	01	01	H1019_103_2	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	1	1	01	01	H1019_104_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	104	2	1	01	01	H1019_104_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								19.99		59.97					0.00		0.00											19.99		59.97				0.00		0.00				19.99				19.99			0.66	0.00		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	105	0	1	01	01	H1019_105_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	105	0	1	01	01	H1019_105_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								36.00		108.00					35.00		105.00											36.00		108.00				35.00		95.00				36.00				36.00			1.20	1.17		1.20	1.17	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	105	0	1	01	01	H1019_105_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								19.99		59.97					0.00		0.00											19.99		59.97				0.00		0.00				19.99				19.99			0.66	0.00		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	106	0	1	01	01	H1019_106_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	106	0	1	01	01	H1019_106_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	106	0	1	01	01	H1019_106_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								19.99		59.97					0.00		0.00											19.99		59.97				0.00		0.00				19.99				19.99			0.66	0.00		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	107	0	1	01	01	H1019_107_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	107	0	1	01	01	H1019_107_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		95.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	107	0	1	01	01	H1019_107_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								19.99		59.97					0.00		0.00											19.99		59.97				0.00		0.00				19.99				19.99			0.66	0.00		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	108	0	1	01	01	H1019_108_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	108	0	1	01	01	H1019_108_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	108	0	1	01	01	H1019_108_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	109	0	1	01	01	H1019_109_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	109	0	1	01	01	H1019_109_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	109	0	1	01	01	H1019_109_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	5		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								19.99		59.97					0.00		0.00											19.99		59.97				0.00		0.00				19.99				19.99			0.66	0.00		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	110	0	1	02	01	H1019_110_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	5		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	110	0	1	02	01	H1019_110_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	110	0	1	02	01	H1019_110_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	111	0	1	01	01	H1019_111_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	111	0	1	01	01	H1019_111_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					10.00		30.00											47.00		141.00				10.00		20.00				47.00				47.00			1.57	0.33		1.57	0.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					55.00		165.00											100.00		300.00				55.00		155.00				100.00				100.00			3.33	1.83		3.33	1.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	111	0	1	01	01	H1019_111_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	112	0	1	01	01	H1019_112_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	112	0	1	01	01	H1019_112_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								30.00		90.00					30.00		90.00											30.00		90.00				30.00		80.00				30.00				30.00			1	1		1	1	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	112	0	1	01	01	H1019_112_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								19.99		59.97					0.00		0.00											19.99		59.97				0.00		0.00				19.99				19.99			0.66	0.00		0.66	0.00	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	113	0	1	01	01	H1019_113_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	113	0	1	01	01	H1019_113_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	113	0	1	01	01	H1019_113_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	040	0	1	01	01	H1032_040_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	25.00		75.00																									25.00		75.00				25.00		50.00				25.00				25.00		0.83				0.83	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	50.00		150.00																									50.00		150.00				50.00		100.00				50.00				50.00		1.67				1.67	1.67	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.84	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.59	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.28	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.57	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.77	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	184	0	1	01	01	H1032_184_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	184	0	1	01	01	H1032_184_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	184	0	1	01	01	H1032_184_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	184	0	1	01	01	H1032_184_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	184	0	1	01	01	H1032_184_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	184	0	1	01	01	H1032_184_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	184	0	1	01	01	H1032_184_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	184	0	1	01	01	H1032_184_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	184	0	1	01	01	H1032_184_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	186	0	1	01	01	H1032_186_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	186	0	1	01	01	H1032_186_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	186	0	1	01	01	H1032_186_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	186	0	1	01	01	H1032_186_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	186	0	1	01	01	H1032_186_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	186	0	1	01	01	H1032_186_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	50.00		150.00																									50.00		150.00				50.00		100.00				50.00				50.00		1.67				1.67	1.67	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	186	0	1	01	01	H1032_186_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	186	0	1	01	01	H1032_186_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	186	0	1	01	01	H1032_186_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	189	0	1	01	01	H1032_189_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	189	0	1	01	01	H1032_189_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	189	0	1	01	01	H1032_189_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	189	0	1	01	01	H1032_189_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	189	0	1	01	01	H1032_189_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.96	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	189	0	1	01	01	H1032_189_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	190	0	1	01	01	H1032_190_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	190	0	1	01	01	H1032_190_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	190	0	1	01	01	H1032_190_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	190	0	1	01	01	H1032_190_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	190	0	1	01	01	H1032_190_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.34	44		44																								44		44				44		44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	190	0	1	01	01	H1032_190_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	191	0	1	01	01	H1032_191_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	191	0	1	01	01	H1032_191_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	192	0	1	01	01	H1032_192_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	192	0	1	01	01	H1032_192_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	192	0	1	01	01	H1032_192_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	192	0	1	01	01	H1032_192_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	192	0	1	01	01	H1032_192_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.98	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	192	0	1	01	01	H1032_192_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	193	0	1	01	01	H1032_193_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	193	0	1	01	01	H1032_193_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	194	0	1	01	01	H1032_194_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	194	0	1	01	01	H1032_194_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	194	0	1	01	01	H1032_194_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	194	0	1	01	01	H1032_194_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	194	0	1	01	01	H1032_194_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	194	0	1	01	01	H1032_194_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	195	0	1	01	01	H1032_195_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	195	0	1	01	01	H1032_195_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	196	0	1	01	01	H1032_196_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	196	0	1	01	01	H1032_196_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	196	0	1	01	01	H1032_196_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	196	0	1	01	01	H1032_196_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	196	0	1	01	01	H1032_196_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	196	0	1	01	01	H1032_196_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	197	0	1	01	01	H1032_197_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	197	0	1	01	01	H1032_197_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	197	0	1	01	01	H1032_197_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	197	0	1	01	01	H1032_197_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.05	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	197	0	1	01	01	H1032_197_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	198	0	1	01	01	H1032_198_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	198	0	1	01	01	H1032_198_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	198	0	1	01	01	H1032_198_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	198	0	1	01	01	H1032_198_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	198	0	1	01	01	H1032_198_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	198	0	1	01	01	H1032_198_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	199	0	1	01	01	H1032_199_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	199	0	1	01	01	H1032_199_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	199	0	1	01	01	H1032_199_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	199	0	1	01	01	H1032_199_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	199	0	1	01	01	H1032_199_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	199	0	1	01	01	H1032_199_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	200	0	1	01	01	H1032_200_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	200	0	1	01	01	H1032_200_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	201	0	1	01	01	H1032_201_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	201	0	1	01	01	H1032_201_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	201	0	1	01	01	H1032_201_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	201	0	1	01	01	H1032_201_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		10.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	201	0	1	01	01	H1032_201_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	201	0	1	01	01	H1032_201_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	202	0	1	01	01	H1032_202_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	202	0	1	01	01	H1032_202_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	202	0	1	01	01	H1032_202_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	202	0	1	01	01	H1032_202_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.32	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	202	0	1	01	01	H1032_202_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	203	0	1	01	01	H1032_203_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	203	0	1	01	01	H1032_203_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	203	0	1	01	01	H1032_203_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	203	0	1	01	01	H1032_203_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	203	0	1	01	01	H1032_203_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	203	0	1	01	01	H1032_203_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	203	0	1	01	01	H1032_203_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	203	0	1	01	01	H1032_203_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	203	0	1	01	01	H1032_203_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	204	0	1	01	01	H1032_204_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	204	0	1	01	01	H1032_204_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	204	0	1	01	01	H1032_204_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	204	0	1	01	01	H1032_204_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	204	0	1	01	01	H1032_204_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.49	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	204	0	1	01	01	H1032_204_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	205	0	1	01	01	H1032_205_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	205	0	1	01	01	H1032_205_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	205	0	1	01	01	H1032_205_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	205	0	1	01	01	H1032_205_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	205	0	1	01	01	H1032_205_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				78.60	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	205	0	1	01	01	H1032_205_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	206	0	1	01	01	H1032_206_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	206	0	1	01	01	H1032_206_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	206	0	1	01	01	H1032_206_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	206	0	1	01	01	H1032_206_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.95	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	206	0	1	01	01	H1032_206_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	209	0	1	01	01	H1032_209_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.22	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	209	0	1	01	01	H1032_209_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	210	0	1	01	01	H1032_210_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	210	0	1	01	01	H1032_210_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	211	0	1	01	01	H1032_211_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	211	0	1	01	01	H1032_211_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	211	0	1	01	01	H1032_211_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	211	0	1	01	01	H1032_211_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	211	0	1	01	01	H1032_211_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	211	0	1	01	01	H1032_211_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	212	0	1	01	01	H1032_212_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		190.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	212	0	1	01	01	H1032_212_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	213	0	1	01	01	H1032_213_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	213	0	1	01	01	H1032_213_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	213	0	1	01	01	H1032_213_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	213	0	1	01	01	H1032_213_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	213	0	1	01	01	H1032_213_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	213	0	1	01	01	H1032_213_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	214	0	1	01	01	H1032_214_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	214	0	1	01	01	H1032_214_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	214	0	1	01	01	H1032_214_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	214	0	1	01	01	H1032_214_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				96.35	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	214	0	1	01	01	H1032_214_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	215	0	1	01	01	H1032_215_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		190.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	215	0	1	01	01	H1032_215_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	216	0	1	01	01	H1032_216_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	216	0	1	01	01	H1032_216_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	216	0	1	01	01	H1032_216_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	216	0	1	01	01	H1032_216_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	216	0	1	01	01	H1032_216_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	216	0	1	01	01	H1032_216_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	217	0	1	01	01	H1032_217_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	217	0	1	01	01	H1032_217_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	217	0	1	01	01	H1032_217_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	217	0	1	01	01	H1032_217_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.74	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	217	0	1	01	01	H1032_217_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	218	0	1	01	01	H1032_218_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	218	0	1	01	01	H1032_218_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1032	218	0	1	01	01	H1032_218_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	218	0	1	01	01	H1032_218_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	218	0	1	01	01	H1032_218_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	218	0	1	01	01	H1032_218_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	224	0	1	01	01	H1032_224_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	224	0	1	01	01	H1032_224_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	224	0	1	01	01	H1032_224_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	224	0	1	01	01	H1032_224_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	224	0	1	01	01	H1032_224_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	224	0	1	01	01	H1032_224_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	224	0	1	01	01	H1032_224_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	224	0	1	01	01	H1032_224_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	224	0	1	01	01	H1032_224_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	225	0	1	01	01	H1032_225_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	225	0	1	01	01	H1032_225_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	225	0	1	01	01	H1032_225_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	225	0	1	01	01	H1032_225_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	225	0	1	01	01	H1032_225_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	225	0	1	01	01	H1032_225_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	225	0	1	01	01	H1032_225_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	225	0	1	01	01	H1032_225_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	225	0	1	01	01	H1032_225_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	226	0	1	01	01	H1032_226_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	226	0	1	01	01	H1032_226_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	226	0	1	01	01	H1032_226_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	226	0	1	01	01	H1032_226_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	226	0	1	01	01	H1032_226_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	226	0	1	01	01	H1032_226_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	226	0	1	01	01	H1032_226_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	226	0	1	01	01	H1032_226_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	226	0	1	01	01	H1032_226_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	227	0	1	01	01	H1032_227_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	227	0	1	01	01	H1032_227_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	227	0	1	01	01	H1032_227_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	227	0	1	01	01	H1032_227_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	227	0	1	01	01	H1032_227_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	227	0	1	01	01	H1032_227_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	227	0	1	01	01	H1032_227_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	227	0	1	01	01	H1032_227_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	227	0	1	01	01	H1032_227_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	228	0	1	01	01	H1032_228_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	228	0	1	01	01	H1032_228_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	228	0	1	01	01	H1032_228_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	228	0	1	01	01	H1032_228_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	228	0	1	01	01	H1032_228_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	228	0	1	01	01	H1032_228_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	228	0	1	01	01	H1032_228_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	228	0	1	01	01	H1032_228_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	228	0	1	01	01	H1032_228_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	229	1	1	01	01	H1032_229_1	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	1	1	01	01	H1032_229_1	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	1	1	01	01	H1032_229_1	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	1	1	01	01	H1032_229_1	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.16	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	1	1	01	01	H1032_229_1	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	2	1	01	01	H1032_229_2	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	2	1	01	01	H1032_229_2	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	2	1	01	01	H1032_229_2	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	2	1	01	01	H1032_229_2	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.16	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	2	1	01	01	H1032_229_2	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	3	1	01	01	H1032_229_3	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	3	1	01	01	H1032_229_3	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	3	1	01	01	H1032_229_3	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	3	1	01	01	H1032_229_3	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.16	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	229	3	1	01	01	H1032_229_3	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	230	0	1	01	01	H1032_230_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	230	0	1	01	01	H1032_230_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	230	0	1	01	01	H1032_230_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	230	0	1	01	01	H1032_230_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	230	0	1	01	01	H1032_230_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	230	0	1	01	01	H1032_230_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	230	0	1	01	01	H1032_230_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	230	0	1	01	01	H1032_230_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	230	0	1	01	01	H1032_230_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	231	0	1	01	01	H1032_231_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	231	0	1	01	01	H1032_231_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	231	0	1	01	01	H1032_231_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	231	0	1	01	01	H1032_231_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	231	0	1	01	01	H1032_231_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	231	0	1	01	01	H1032_231_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	231	0	1	01	01	H1032_231_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	231	0	1	01	01	H1032_231_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	231	0	1	01	01	H1032_231_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	232	0	1	01	01	H1032_232_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	232	0	1	01	01	H1032_232_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	232	0	1	01	01	H1032_232_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	232	0	1	01	01	H1032_232_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	232	0	1	01	01	H1032_232_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	232	0	1	01	01	H1032_232_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	75.00		225.00																									75.00		225.00				75.00		150.00				75.00				75.00		2.5				2.5	2.5	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	232	0	1	01	01	H1032_232_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	232	0	1	01	01	H1032_232_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	232	0	1	01	01	H1032_232_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1032	233	0	1	01	01	H1032_233_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	233	0	1	01	01	H1032_233_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1032	233	0	1	01	01	H1032_233_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	233	0	1	01	01	H1032_233_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1032	233	0	1	01	01	H1032_233_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	233	0	1	01	01	H1032_233_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	233	0	1	01	01	H1032_233_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	233	0	1	01	01	H1032_233_0	4		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1032	233	0	1	01	01	H1032_233_0	4		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1035	002	0	1	02	01	H1035_002_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	002	0	1	02	01	H1035_002_0	8		N	Generic	4	01	1	2	2	1		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					2.00	4.00	6.00						2.00	3.00																20.00				20.00			0.65	0.06				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	8		N	Generic	4	01	1	2	2	3		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					2.00	4.00	6.00						2.00	3.00																20.00				20.00			0.65	0.06				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	002	0	1	02	01	H1035_002_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	101		1				31	62	93	2	1		62	93				31		31								47.00	94.00	141.00					42.00	84.00	126.00						82.00	123.00																47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	8		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	101		1				31	62	93	2	1		62	93				31		31								100.00	200.00	300.00					92.00	184.00	276.00						182.00	273.00																100.00				100.00			3.23	2.97				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											644.91	33						207.05	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	6		N	Generic	4	01	1	2	2	1		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					6.00	12.00	18.00						10.00	15.00																20.00				20.00			0.65	0.19				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	101		1				31	62	93	2	1		62	93				31		31								47.00	94.00	141.00					44.00	88.00	132.00						86.00	129.00																47.00				47.00			1.52	1.42				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	101		1				31	62	93	2	1		62	93				31		31								100.00	200.00	300.00					95.00	190.00	285.00						188.00	282.00																100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											706.18	26						238.68	26																							26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	011	0	1	01	01	H1035_011_0	6		N	Generic	4	01	1	2	2	1		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					7.00	14.00	21.00						12.00	18.00																20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	6		N	Generic	4	01	1	2	2	3		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					7.00	14.00	21.00						12.00	18.00																20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	011	0	1	01	01	H1035_011_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	101		1				31	62	93	2	1		62	93				31		31								47.00	94.00	141.00					45.00	90.00	135.00						88.00	132.00																47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	101		1				31	62	93	2	1		62	93				31		31								100.00	200.00	300.00					98.00	196.00	294.00						194.00	291.00																100.00				100.00			3.23	3.16				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	011	0	1	01	01	H1035_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											657.97	33						195.74	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					4.00	8.00	12.00						6.00	9.00																17.00				17.00			0.55	0.13				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	6		N	Generic	4	01	1	2	2	1		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					10.00	20.00	30.00						18.00	27.00																20.00				20.00			0.65	0.32				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	101		1				31	62	93	2	1		62	93				31		31								47.00	94.00	141.00					45.00	90.00	135.00						88.00	132.00																47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	101		1				31	62	93	2	1		62	93				31		31								100.00	200.00	300.00					98.00	196.00	294.00						194.00	291.00																100.00				100.00			3.23	3.16				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	014	0	1	01	01	H1035_014_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											885.79	25						244.46	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	016	0	1	01	01	H1035_016_0	8		N	Generic	4	01	1	2	2	1		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					5.00	10.00	15.00						8.00	12.00																20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	8		N	Generic	4	01	1	2	2	3		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					5.00	10.00	15.00						8.00	12.00																20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	016	0	1	01	01	H1035_016_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	101		1				31	62	93	2	1		62	93				31		31								47.00	94.00	141.00					44.00	88.00	132.00						86.00	129.00																47.00				47.00			1.52	1.42				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	8		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	101		1				31	62	93	2	1		62	93				31		31								100.00	200.00	300.00					95.00	190.00	285.00						188.00	282.00																100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	016	0	1	01	01	H1035_016_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											1078.62	33						295.01	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	017	0	1	01	01	H1035_017_0	9		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	017	0	1	01	01	H1035_017_0	9		Y	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	017	0	1	01	01	H1035_017_0	9		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	017	0	1	01	01	H1035_017_0	9		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	017	0	1	01	01	H1035_017_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					35.00		105.00					35.00		105.00																47.00				35.00			1.52	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	017	0	1	01	01	H1035_017_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	017	0	1	01	01	H1035_017_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1161.99	33						1161.99	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	018	0	1	01	01	H1035_018_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_0	8		Y	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	018	0	1	01	01	H1035_018_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					2.00		6.00					2.00		6.00																15.00				2.00			0.48	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					2.00		6.00					2.00		6.00																15.00				2.00			0.48	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	018	0	1	01	01	H1035_018_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					35.00		105.00					35.00		105.00																47.00				35.00			1.52	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1366.33	33						1366.33	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_0	8		Y	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	018	0	1	01	01	H1035_018_0	8		Y	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	019	0	1	01	01	H1035_019_0	9		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_0	9		Y	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	019	0	1	01	01	H1035_019_0	9		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				10.00			0.48	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1208.72	33						1208.72	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_0	9		Y	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	019	0	1	01	01	H1035_019_0	9		Y	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	020	0	1	01	01	H1035_020_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	8		Y	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	020	0	1	01	01	H1035_020_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	020	0	1	01	01	H1035_020_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1060.38	33						1060.38	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	8		Y	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	020	0	1	01	01	H1035_020_0	8		Y	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	021	0	1	01	01	H1035_021_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					0.00		0.00					0.00		0.00																14.00				0.00			0.45	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	8		Y	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					0.00		0.00					0.00		0.00																14.00				0.00			0.45	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	021	0	1	01	01	H1035_021_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					8.00		24.00					8.00		24.00																20.00				8.00			0.65	0.26	0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					8.00		24.00					8.00		24.00																20.00				8.00			0.65	0.26	0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	021	0	1	01	01	H1035_021_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1127.94	33						1127.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	8		Y	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	021	0	1	01	01	H1035_021_0	8		Y	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	022	0	1	01	01	H1035_022_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	022	0	1	01	01	H1035_022_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	022	0	1	01	01	H1035_022_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	022	0	1	01	01	H1035_022_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	022	0	1	01	01	H1035_022_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					35.00		105.00					35.00		105.00																47.00				35.00			1.52	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	022	0	1	01	01	H1035_022_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	022	0	1	01	01	H1035_022_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1190.76	33						1190.76	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	023	0	1	01	01	H1035_023_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	023	0	1	01	01	H1035_023_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	023	0	1	01	01	H1035_023_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	023	0	1	01	01	H1035_023_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	023	0	1	01	01	H1035_023_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					25.00		75.00					25.00		75.00																45.00				25.00			1.45	0.81	0.81			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	023	0	1	01	01	H1035_023_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								90.00		270.00					80.00		240.00					80.00		240.00																90.00				80.00			2.90	2.58	2.58			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	023	0	1	01	01	H1035_023_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1309.15	33						1309.15	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	024	0	1	01	01	H1035_024_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	024	0	1	01	01	H1035_024_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	024	0	1	01	01	H1035_024_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	024	0	1	01	01	H1035_024_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	024	0	1	01	01	H1035_024_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								12.00		36.00					0.00		0.00					0.00		0.00																12.00				0.00			0.39	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	024	0	1	01	01	H1035_024_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								75.00		225.00					50.00		150.00					50.00		150.00																75.00				50.00			2.42	1.61	1.61			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	024	0	1	01	01	H1035_024_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1063.15	33						1063.15	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	025	0	1	01	01	H1035_025_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	025	0	1	01	01	H1035_025_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	025	0	1	01	01	H1035_025_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	025	0	1	01	01	H1035_025_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	025	0	1	01	01	H1035_025_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					20.00		60.00					20.00		60.00																45.00				20.00			1.45	0.65	0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	025	0	1	01	01	H1035_025_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	025	0	1	01	01	H1035_025_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											865.97	33						865.97	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	026	0	1	01	01	H1035_026_0	9		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	026	0	1	01	01	H1035_026_0	9		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	026	0	1	01	01	H1035_026_0	9		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	026	0	1	01	01	H1035_026_0	9		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	026	0	1	01	01	H1035_026_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					30.00		90.00					30.00		90.00																40.00				30.00			1.29	0.97	0.97			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	026	0	1	01	01	H1035_026_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	026	0	1	01	01	H1035_026_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1246.21	33						1246.21	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	11		N	Preferred Generic	4	01	3	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	11		N	Preferred Generic	4	01	3	2	1	3		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	027	0	1	01	01	H1035_027_0	11		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	11		N	Generic	4	01	1	2	2	3		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	027	0	1	01	01	H1035_027_0	11		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		120.00				47.00				40.00			1.52	1.29		1.52	1.29	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	11		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								99.00		297.00					92.00		276.00											99.00		297.00				92.00		276.00				99.00				92.00			3.19	2.97		3.19	2.97	2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	027	0	1	01	01	H1035_027_0	11		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											768.25	25						768.25	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	9		N	Preferred Generic	4	01	3	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	9		N	Preferred Generic	4	01	3	2	1	3		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	028	0	1	01	01	H1035_028_0	9		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	9		N	Generic	4	01	1	2	2	3		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	028	0	1	01	01	H1035_028_0	9		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		120.00				47.00				40.00			1.52	1.29		1.52	1.29	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								99.00		297.00					92.00		276.00											99.00		297.00				92.00		276.00				99.00				92.00			3.19	2.97		3.19	2.97	2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	028	0	1	01	01	H1035_028_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											797.54	25						797.54	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	029	0	1	01	01	H1035_029_0	9		N	Preferred Generic	4	01	3	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	029	0	1	01	01	H1035_029_0	9		N	Preferred Generic	4	01	3	2	1	3		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	029	0	1	01	01	H1035_029_0	9		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	029	0	1	01	01	H1035_029_0	9		N	Generic	4	01	1	2	2	3		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	029	0	1	01	01	H1035_029_0	9		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		120.00				47.00				40.00			1.52	1.29		1.52	1.29	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	029	0	1	01	01	H1035_029_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								99.00		297.00					92.00		276.00											99.00		297.00				92.00		276.00				99.00				92.00			3.19	2.97		3.19	2.97	2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	029	0	1	01	01	H1035_029_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											772.42	25						772.42	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	030	0	1	01	01	H1035_030_0	8		N	Preferred Generic	4	01	3	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	030	0	1	01	01	H1035_030_0	8		N	Preferred Generic	4	01	3	2	1	3		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	030	0	1	01	01	H1035_030_0	8		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	030	0	1	01	01	H1035_030_0	8		N	Generic	4	01	1	2	2	3		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	030	0	1	01	01	H1035_030_0	8		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		120.00				47.00				40.00			1.52	1.29		1.52	1.29	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	030	0	1	01	01	H1035_030_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								99.00		297.00					92.00		276.00											99.00		297.00				92.00		276.00				99.00				92.00			3.19	2.97		3.19	2.97	2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	030	0	1	01	01	H1035_030_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											767.74	25						767.74	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	031	0	1	01	01	H1035_031_0	8		N	Preferred Generic	4	01	3	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	031	0	1	01	01	H1035_031_0	8		N	Preferred Generic	4	01	3	2	1	3		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	031	0	1	01	01	H1035_031_0	8		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	031	0	1	01	01	H1035_031_0	8		N	Generic	4	01	1	2	2	3		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	031	0	1	01	01	H1035_031_0	8		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		120.00				47.00				40.00			1.52	1.29		1.52	1.29	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	031	0	1	01	01	H1035_031_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								99.00		297.00					92.00		276.00											99.00		297.00				92.00		276.00				99.00				92.00			3.19	2.97		3.19	2.97	2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	031	0	1	01	01	H1035_031_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											768.85	25						768.85	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	032	0	1	01	01	H1035_032_0	8		N	Preferred Generic	4	01	3	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	032	0	1	01	01	H1035_032_0	8		N	Preferred Generic	4	01	3	2	1	3		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				0.00			0.32	0.00		0.32	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	032	0	1	01	01	H1035_032_0	8		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	032	0	1	01	01	H1035_032_0	8		N	Generic	4	01	1	2	2	3		110	01		110	1				31		90	1	2				31		90	31		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				0.00			0.35	0.00		0.35	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	032	0	1	01	01	H1035_032_0	8		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		120.00				47.00				40.00			1.52	1.29		1.52	1.29	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	032	0	1	01	01	H1035_032_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				31		90	1	2				31		90	31		31								99.00		297.00					92.00		276.00											99.00		297.00				92.00		276.00				99.00				92.00			3.19	2.97		3.19	2.97	2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	032	0	1	01	01	H1035_032_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											771.78	25						771.78	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	033	0	1	01	01	H1035_033_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	033	0	1	01	01	H1035_033_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	033	0	1	01	01	H1035_033_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	033	0	1	01	01	H1035_033_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	033	0	1	01	01	H1035_033_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	033	0	1	01	01	H1035_033_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	033	0	1	01	01	H1035_033_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1080.76	33						1080.76	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	034	0	1	01	01	H1035_034_0	9		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	034	0	1	01	01	H1035_034_0	9		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	034	0	1	01	01	H1035_034_0	9		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	034	0	1	01	01	H1035_034_0	9		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					0.00		0.00					0.00		0.00																15.00				0.00			0.48	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	034	0	1	01	01	H1035_034_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					30.00		90.00					30.00		90.00																47.00				30.00			1.52	0.97	0.97			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	034	0	1	01	01	H1035_034_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					90.00		270.00					90.00		270.00																100.00				90.00			3.23	2.90	2.90			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	034	0	1	01	01	H1035_034_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1225.10	33						1225.10	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	035	0	1	01	01	H1035_035_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	3.00		9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	035	0	1	01	01	H1035_035_0	8		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	12.00		36.00																			12.00		36.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	035	0	1	01	01	H1035_035_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	035	0	1	01	01	H1035_035_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	035	0	1	01	01	H1035_035_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				879.60	32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	035	0	1	01	01	H1035_035_0	8		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	035	0	1	01	01	H1035_035_0	8		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	037	0	1	01	01	H1035_037_0	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	3.00		9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	9		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	12.00		36.00																			12.00		36.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	9		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				879.89	32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	9		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	037	0	1	01	01	H1035_037_0	9		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	038	0	1	01	01	H1035_038_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	3.00		9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	038	0	1	01	01	H1035_038_0	8		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	12.00		36.00																			12.00		36.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	038	0	1	01	01	H1035_038_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	038	0	1	01	01	H1035_038_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	038	0	1	01	01	H1035_038_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				885.11	32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	038	0	1	01	01	H1035_038_0	8		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1035	038	0	1	01	01	H1035_038_0	8		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1035	039	0	1	01	01	H1035_039_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	039	0	1	01	01	H1035_039_0	8		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	039	0	1	01	01	H1035_039_0	8		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	039	0	1	01	01	H1035_039_0	8		Y	Generic	4	01	1	2	2	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	039	0	1	01	01	H1035_039_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	25.00		75.00																			25.00		75.00																25.00				25.00		0.81			0.81			0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	039	0	1	01	01	H1035_039_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	50.00		150.00																			50.00		150.00																50.00				50.00		1.61			1.61			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	039	0	1	01	01	H1035_039_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				911.11	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	040	0	1	01	01	H1035_040_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	040	0	1	01	01	H1035_040_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					0.00	0.00	0.00						0.00	0.00																17.00				17.00			0.55	0.00				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	040	0	1	01	01	H1035_040_0	5		N	Generic	4	01	1	2	2	1		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					5.00	10.00	15.00						8.00	12.00																20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	040	0	1	01	01	H1035_040_0	5		N	Generic	4	01	1	2	2	3		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					5.00	10.00	15.00						8.00	12.00																20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1035	040	0	1	01	01	H1035_040_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	101		1				31	62	93	2	1		62	93				31		31								47.00	94.00	141.00					44.00	88.00	132.00						86.00	129.00																47.00				47.00			1.52	1.42				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	040	0	1	01	01	H1035_040_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	101		1				31	62	93	2	1		62	93				31		31								100.00	200.00	300.00					95.00	190.00	285.00						188.00	282.00																100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	040	0	1	01	01	H1035_040_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											657.74	33						195.72	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	043	0	1	01	01	H1035_043_0	9		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	043	0	1	01	01	H1035_043_0	9		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	043	0	1	01	01	H1035_043_0	9		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	043	0	1	01	01	H1035_043_0	9		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								11.00		33.00					0.00		0.00					0.00		0.00																11.00				0.00			0.35	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	043	0	1	01	01	H1035_043_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	043	0	1	01	01	H1035_043_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	043	0	1	01	01	H1035_043_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1604.08	33						1604.08	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	044	0	1	02	01	H1035_044_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	101		1				31	62	93	2	1		62	93				31		31								17.00	34.00	51.00					4.00	8.00	12.00						6.00	9.00																17.00				17.00			0.55	0.13				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	044	0	1	02	01	H1035_044_0	8		N	Generic	4	01	1	2	2	1		111	01	101		1				31	62	93	2	1		62	93				31		31								20.00	40.00	60.00					10.00	20.00	30.00						18.00	27.00																20.00				20.00			0.65	0.32				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	044	0	1	02	01	H1035_044_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	101		1				31	62	93	2	1		62	93				31		31								47.00	94.00	141.00					45.00	90.00	135.00						88.00	132.00																47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	044	0	1	02	01	H1035_044_0	8		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	101		1				31	62	93	2	1		62	93				31		31								100.00	200.00	300.00					98.00	196.00	294.00						194.00	291.00																100.00				100.00			3.23	3.16				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	044	0	1	02	01	H1035_044_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01			1				31											31		31											661.71	25						224.77	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1035	045	0	1	01	01	H1035_045_0	8		Y	Preferred Generic	4	01	3	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	045	0	1	01	01	H1035_045_0	8		Y	Preferred Generic	4	01	3	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1035	045	0	1	01	01	H1035_045_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					2.00		6.00					2.00		6.00																15.00				2.00			0.48	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	045	0	1	01	01	H1035_045_0	8		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					2.00		6.00					2.00		6.00																15.00				2.00			0.48	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1035	045	0	1	01	01	H1035_045_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					30.00		90.00					30.00		90.00																47.00				30.00			1.52	0.97	0.97			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	045	0	1	01	01	H1035_045_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					90.00		270.00					90.00		270.00																100.00				90.00			3.23	2.90	2.90			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	045	0	1	01	01	H1035_045_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1794.77	33						1794.77	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	025	0	1	01	01	H1036_025_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	025	0	1	01	01	H1036_025_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					55.00		165.00											100.00		300.00				55.00		155.00				100.00				100.00			3.33	1.83		3.33	1.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	044	0	1	01	01	H1036_044_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	044	0	1	01	01	H1036_044_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	054	0	1	01	01	H1036_054_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	054	0	1	01	01	H1036_054_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								50.00		150.00					5.00		15.00											50.00		150.00				5.00		5.00				50.00				50.00			1.67	0.17		1.67	0.17	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	062	0	1	01	01	H1036_062_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	062	0	1	01	01	H1036_062_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					20.00		60.00											47.00		141.00				20.00		50.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					75.00		225.00											100.00		300.00				75.00		215.00				100.00				100.00			3.33	2.50		3.33	2.50	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	065	0	1	01	01	H1036_065_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	065	0	1	01	01	H1036_065_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					75.00		225.00											100.00		300.00				75.00		215.00				100.00				100.00			3.33	2.50		3.33	2.50	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	068	0	1	01	01	H1036_068_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	068	0	1	01	01	H1036_068_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					89.00		267.00											100.00		300.00				89.00		257.00				100.00				100.00			3.33	2.97		3.33	2.97	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	074	0	1	01	01	H1036_074_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	074	0	1	01	01	H1036_074_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					10.00		30.00											47.00		141.00				10.00		20.00				47.00				47.00			1.57	0.33		1.57	0.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					60.00		180.00											100.00		300.00				60.00		170.00				100.00				100.00			3.33	2		3.33	2	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	5		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	081	0	1	01	01	H1036_081_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	5		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	081	0	1	01	01	H1036_081_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					89.00		267.00											100.00		300.00				89.00		257.00				100.00				100.00			3.33	2.97		3.33	2.97	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	5		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	121	0	1	01	01	H1036_121_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	121	0	1	01	01	H1036_121_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	140	0	1	01	01	H1036_140_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	140	0	1	01	01	H1036_140_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					75.00		225.00											100.00		300.00				75.00		215.00				100.00				100.00			3.33	2.50		3.33	2.50	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1036	143	0	1	01	01	H1036_143_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3		Y	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3		Y	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	3		Y	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												15							15												15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	146	0	1	01	01	H1036_146_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	146	0	1	01	01	H1036_146_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	146	0	1	01	01	H1036_146_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	156	0	1	01	01	H1036_156_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	3		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	3		Y	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	157	0	1	01	01	H1036_157_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	160	0	1	01	01	H1036_160_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	2		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	160	0	1	01	01	H1036_160_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	2		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	2		Y	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					5.00		15.00											47.00		141.00				5.00		5.00				47.00				47.00			1.57	0.17		1.57	0.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					35.00		105.00											100.00		300.00				35.00		95.00				100.00				100.00			3.33	1.17		3.33	1.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	2		Y	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					35.00		105.00											100.00		300.00				35.00		95.00				100.00				100.00			3.33	1.17		3.33	1.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	2		Y	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												15							15												15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	2		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	2		Y	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	167	0	1	01	01	H1036_167_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.07		0.13	0.07	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					13.00		39.00											18.00		54.00				13.00		0.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	175	0	1	01	01	H1036_175_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	175	0	1	01	01	H1036_175_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3		Y	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					89.00		267.00											100.00		300.00				89.00		257.00				100.00				100.00			3.33	2.97		3.33	2.97	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3		Y	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					89.00		267.00											100.00		300.00				89.00		257.00				100.00				100.00			3.33	2.97		3.33	2.97	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3		Y	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												15							15												15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3		Y	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					0.00		0.00											11.00		33.00				0.00		0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	199	0	1	01	01	H1036_199_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					1.00		3.00											20.00		60.00				1.00		0.00				20.00				20.00			0.67	0.03		0.67	0.03	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	217	0	1	01	01	H1036_217_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	217	0	1	01	01	H1036_217_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	230	0	1	01	01	H1036_230_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	230	0	1	01	01	H1036_230_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					30.00		90.00											47.00		141.00				30.00		80.00				47.00				47.00			1.57	1		1.57	1	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	6		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	6		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					1.00		3.00											20.00		60.00				1.00		0.00				20.00				20.00			0.67	0.03		0.67	0.03	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	234	0	1	01	01	H1036_234_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	3		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	235	0	1	01	01	H1036_235_0	4		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	4		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	1	1	01	01	H1036_265_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	265	2	1	01	01	H1036_265_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	266	0	1	01	01	H1036_266_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	268	0	1	01	01	H1036_268_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	2		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	269	0	1	01	01	H1036_269_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	2		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	269	0	1	01	01	H1036_269_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	269	0	1	01	01	H1036_269_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	270	0	1	01	01	H1036_270_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	271	0	1	01	01	H1036_271_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					1.00		3.00											19.00		57.00				1.00		0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	276	0	1	01	01	H1036_276_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	277	0	1	01	01	H1036_277_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	277	0	1	01	01	H1036_277_0	4		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	277	0	1	01	01	H1036_277_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	277	0	1	01	01	H1036_277_0	4		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	277	0	1	01	01	H1036_277_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	277	0	1	01	01	H1036_277_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		260.00				100.00				100.00			3.33	3		3.33	3	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	277	0	1	01	01	H1036_277_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	2		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	278	0	1	01	01	H1036_278_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	2		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	278	0	1	01	01	H1036_278_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	278	0	1	01	01	H1036_278_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	280	0	1	01	01	H1036_280_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	281	0	1	01	01	H1036_281_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	281	0	1	01	01	H1036_281_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	281	0	1	01	01	H1036_281_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	281	0	1	01	01	H1036_281_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	281	0	1	01	01	H1036_281_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	282	0	1	01	01	H1036_282_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	282	0	1	01	01	H1036_282_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	282	0	1	01	01	H1036_282_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	282	0	1	01	01	H1036_282_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	282	0	1	01	01	H1036_282_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	283	0	1	01	01	H1036_283_0	5		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	283	0	1	01	01	H1036_283_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	283	0	1	01	01	H1036_283_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	283	0	1	01	01	H1036_283_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	283	0	1	01	01	H1036_283_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	284	0	1	01	01	H1036_284_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	285	0	1	01	01	H1036_285_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	286	0	1	01	01	H1036_286_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	291	0	1	01	01	H1036_291_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	001	0	1	01	01	H1045_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	001	0	1	01	01	H1045_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	40.00		120.00																											120.00						110.00				40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				385.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	005	0	1	01	01	H1045_005_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	005	0	1	01	01	H1045_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				375.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	012	0	1	01	01	H1045_012_0	4		N	Generic	4	01	3	2	2	1	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4		N	Generic	4	01	3	2	2	3	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	012	0	1	01	01	H1045_012_0	4		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				2	2			100				30		31				43.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				2	2			100				30		31				49.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				212.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	018	0	1	01	01	H1045_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						35.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	3		Y	Preferred Brand	4	11	1	2	3	3	110		01		100	1	30		100				2	2						100	30		31	15.00		45.00																											45.00						35.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				292.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	025	0	1	01	01	H1045_025_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				394.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	026	0	1	02	01	H1045_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	02	01	H1045_026_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				374.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	028	0	1	02	01	H1045_028_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	02	01	H1045_028_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				373.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	030	0	1	02	01	H1045_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	02	01	H1045_030_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				456.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	031	0	1	02	01	H1045_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				516.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	032	0	1	02	01	H1045_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				427.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	033	0	1	01	01	H1045_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				378.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	034	0	1	01	01	H1045_034_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	034	0	1	01	01	H1045_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				476.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	036	0	1	02	01	H1045_036_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	02	01	H1045_036_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				366.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	037	0	1	01	01	H1045_037_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	037	0	1	01	01	H1045_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				329.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	3		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	038	0	1	01	01	H1045_038_0	3		N	Generic	4	01	3	2	2	1	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	3		N	Generic	4	01	3	2	2	3	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	038	0	1	01	01	H1045_038_0	3		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				2	2			100				30		31				48.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				2	2			100				30		31				45.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				271.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	041	0	1	02	01	H1045_041_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				461.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	042	0	1	02	01	H1045_042_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	02	01	H1045_042_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				434.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	043	0	1	02	01	H1045_043_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	02	01	H1045_043_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				422.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	045	0	1	02	01	H1045_045_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	045	0	1	02	01	H1045_045_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	045	0	1	02	01	H1045_045_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				454.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	01	01	H1045_048_1	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	01	01	H1045_048_1	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	01	01	H1045_048_1	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	048	1	1	01	01	H1045_048_1	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	01	01	H1045_048_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	1	1	01	01	H1045_048_1	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											284.00	30						428.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	01	01	H1045_048_2	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	01	01	H1045_048_2	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	01	01	H1045_048_2	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	048	2	1	01	01	H1045_048_2	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	01	01	H1045_048_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	2	1	01	01	H1045_048_2	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											284.00	30						428.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	01	01	H1045_048_3	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	01	01	H1045_048_3	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	01	01	H1045_048_3	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	048	3	1	01	01	H1045_048_3	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	01	01	H1045_048_3	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	3	1	01	01	H1045_048_3	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											284.00	30						428.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	01	01	H1045_048_4	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	01	01	H1045_048_4	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	01	01	H1045_048_4	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1045	048	4	1	01	01	H1045_048_4	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	01	01	H1045_048_4	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	048	4	1	01	01	H1045_048_4	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											284.00	30						428.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					3.00		9.00							9.00																5.00				5.00			0.17	0.10				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	5		N	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					3.00		9.00							9.00																5.00				5.00			0.17	0.10				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	001	0	1	02	01	H1099_001_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							30.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	5		N	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							30.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	001	0	1	02	01	H1099_001_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							112.50																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								90.00		270.00					80.00		240.00							225.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											536.14	33						333.30	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	5		N	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	5		N	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	006	0	1	01	01	H1099_006_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					3.00		9.00							9.00																5.00				5.00			0.17	0.10				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							30.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							112.50																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								90.00		270.00					80.00		240.00							225.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											589.43	33						336.60	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	5		N	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	5		N	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	014	0	1	01	01	H1099_014_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				356.08	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	6		N	Select Care Drugs	4	01	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	01	01	H1099_016_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					2.00		6.00							0.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	01	01	H1099_016_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							0.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	01	01	H1099_016_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					45.00		135.00							112.50																47.00				47.00			1.57	1.50				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	01	01	H1099_016_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	01	01	H1099_016_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											744.92	33						333.13	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	01	01	H1099_016_0	5		N	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	01	01	H1099_016_0	5		N	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1100	001	0	1	04	01	H1100_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	001	0	1	04	01	H1100_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1100	001	0	1	04	01	H1100_001_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	001	0	1	04	01	H1100_001_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1100	001	0	1	04	01	H1100_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	001	0	1	04	01	H1100_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	001	0	1	04	01	H1100_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											508.38	29						348.91	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	002	0	1	04	01	H1100_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	002	0	1	04	01	H1100_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1100	002	0	1	04	01	H1100_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	002	0	1	04	01	H1100_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1100	002	0	1	04	01	H1100_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	002	0	1	04	01	H1100_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1100	002	0	1	04	01	H1100_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											636.57	30						468.48	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	005	0	1	01	01	H1109_005_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	005	0	1	01	01	H1109_005_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1109	005	0	1	01	01	H1109_005_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	005	0	1	01	01	H1109_005_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1109	005	0	1	01	01	H1109_005_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	005	0	1	01	01	H1109_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	005	0	1	01	01	H1109_005_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											550.29	28						437.62	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	006	0	1	01	01	H1109_006_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	006	0	1	01	01	H1109_006_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1109	006	0	1	01	01	H1109_006_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	006	0	1	01	01	H1109_006_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1109	006	0	1	01	01	H1109_006_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	006	0	1	01	01	H1109_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1109	006	0	1	01	01	H1109_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											660.53	28						459.30	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1111	009	1	1	01	01	H1111_009_1	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	1	1	01	01	H1111_009_1	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		10.00													45.00						10.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	1	1	01	01	H1111_009_1	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		10.00													45.00						10.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1111	009	1	1	01	01	H1111_009_1	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	1	1	01	01	H1111_009_1	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								95.00		285.00					95.00		275.00													285.00						275.00				95.00				95.00			3.16	3.16				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	1	1	01	01	H1111_009_1	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											225.00	28						260.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	2	1	01	01	H1111_009_2	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	2	1	01	01	H1111_009_2	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		10.00													45.00						10.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	2	1	01	01	H1111_009_2	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		10.00													45.00						10.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1111	009	2	1	01	01	H1111_009_2	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	2	1	01	01	H1111_009_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								95.00		285.00					95.00		275.00													285.00						275.00				95.00				95.00			3.16	3.16				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	009	2	1	01	01	H1111_009_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											225.00	28						260.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.24	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.75	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H1112	035	0	1	01	01	H1112_035_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.63	40		40																								40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	037	0	1	01	01	H1112_037_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	037	0	1	01	01	H1112_037_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1112	037	0	1	01	01	H1112_037_0	6		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	037	0	1	01	01	H1112_037_0	6		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1112	037	0	1	01	01	H1112_037_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	037	0	1	01	01	H1112_037_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				62.77	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	037	0	1	01	01	H1112_037_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	037	0	1	01	01	H1112_037_0	6		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1112	037	0	1	01	01	H1112_037_0	6		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1112	038	0	1	01	01	H1112_038_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	038	0	1	01	01	H1112_038_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H1112	038	0	1	01	01	H1112_038_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	038	0	1	01	01	H1112_038_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	038	0	1	01	01	H1112_038_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.34	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	038	0	1	01	01	H1112_038_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	039	0	1	01	01	H1112_039_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	039	0	1	01	01	H1112_039_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H1112	039	0	1	01	01	H1112_039_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	039	0	1	01	01	H1112_039_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	039	0	1	01	01	H1112_039_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.48	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	039	0	1	01	01	H1112_039_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	040	0	1	01	01	H1112_040_0	7		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	040	0	1	01	01	H1112_040_0	7		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1112	040	0	1	01	01	H1112_040_0	7		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	040	0	1	01	01	H1112_040_0	7		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1112	040	0	1	01	01	H1112_040_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	040	0	1	01	01	H1112_040_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	040	0	1	01	01	H1112_040_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	042	0	1	01	01	H1112_042_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	042	0	1	01	01	H1112_042_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	042	0	1	01	01	H1112_042_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	042	0	1	01	01	H1112_042_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				76.21	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	042	0	1	01	01	H1112_042_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	043	0	1	01	01	H1112_043_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	043	0	1	01	01	H1112_043_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	043	0	1	01	01	H1112_043_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	043	0	1	01	01	H1112_043_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				77.78	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	043	0	1	01	01	H1112_043_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	044	0	1	01	01	H1112_044_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	044	0	1	01	01	H1112_044_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	044	0	1	01	01	H1112_044_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	044	0	1	01	01	H1112_044_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.28	43		43																								43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	044	0	1	01	01	H1112_044_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1142	001	0	1	01	01	H1142_001_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	001	0	1	01	01	H1142_001_0	6		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	001	0	1	01	01	H1142_001_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	001	0	1	01	01	H1142_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	001	0	1	01	01	H1142_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				847.62	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	001	0	1	01	01	H1142_001_0	6		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	001	0	1	01	01	H1142_001_0	6		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1142	002	0	1	01	01	H1142_002_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	002	0	1	01	01	H1142_002_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	002	0	1	01	01	H1142_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	002	0	1	01	01	H1142_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	002	0	1	01	01	H1142_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				736.15	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	002	0	1	01	01	H1142_002_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	002	0	1	01	01	H1142_002_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1142	003	0	1	01	01	H1142_003_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	003	0	1	01	01	H1142_003_0	6		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	003	0	1	01	01	H1142_003_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	003	0	1	01	01	H1142_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	003	0	1	01	01	H1142_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				603.36	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	003	0	1	01	01	H1142_003_0	6		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	003	0	1	01	01	H1142_003_0	6		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1142	013	0	1	01	01	H1142_013_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	013	0	1	01	01	H1142_013_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	013	0	1	01	01	H1142_013_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	013	0	1	01	01	H1142_013_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	013	0	1	01	01	H1142_013_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				608.72	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	013	0	1	01	01	H1142_013_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1142	013	0	1	01	01	H1142_013_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1170	002	0	1	01	01	H1170_002_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	10		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	10		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	10		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	10		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				818.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	10		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	10		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	008	0	1	01	01	H1170_008_0	10		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	10		N	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	10		N	Preferred Brand	3	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	10		N	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	10		N	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				664.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	10		N	Vaccines	3	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.16			3.16			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				791.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1189	001	0	1	01	01	H1189_001_0	4		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	4		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																10.00				10.00		0.32						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	4		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	4		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				95.51	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	4		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				646.71	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	002	0	1	01	01	H1189_002_0	4		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	002	0	1	01	01	H1189_002_0	4		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																10.00				10.00		0.32						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	002	0	1	01	01	H1189_002_0	4		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	002	0	1	01	01	H1189_002_0	4		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				99.69	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	002	0	1	01	01	H1189_002_0	4		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				768.58	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																10.00				10.00		0.32						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				98.67	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	003	0	1	01	01	H1189_003_0	4		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				766.37	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					0.00																10.00				10.00		0.32						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4		N	Non-Preferred Drug	4	10	1	1	4	1	110		01	100		1	31		90				1	2			90				31		34				98.63	26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	004	0	1	01	01	H1189_004_0	4		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				691.12	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	7		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1225	001	0	1	01	01	H1225_001_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	15.00	20.00																			10.00	15.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	70.50	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	001	0	1	01	01	H1225_001_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	002	0	1	01	01	H1225_002_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	002	0	1	01	01	H1225_002_0	7		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1225	002	0	1	01	01	H1225_002_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	15.00	20.00																			10.00	15.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	002	0	1	01	01	H1225_002_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	70.50	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	002	0	1	01	01	H1225_002_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1225	002	0	1	01	01	H1225_002_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1230	001	0	1	01	01	H1230_001_0	12		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	12		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	12		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				704.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	12		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	13		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	13		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	13		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	13		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	13		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	13		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	13		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				749.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	13		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	13		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	013	0	1	01	01	H1230_013_0	12		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	12		N	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	17.00	34.00	51.00																			17.00	34.00	34.00																17.00				17.00		0.56			0.56			0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	12		N	Preferred Brand	3	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	12		N	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	12		N	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				553.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	12		N	Vaccines	3	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12		N	Generic	3	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12		N	Preferred Brand	3	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12		N	Non-Preferred Brand	3	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12		N	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				770.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	12		N	Vaccines	3	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1248	001	0	1	04	01	H1248_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	001	0	1	04	01	H1248_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	001	0	1	04	01	H1248_001_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	001	0	1	04	01	H1248_001_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	001	0	1	04	01	H1248_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	001	0	1	04	01	H1248_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	001	0	1	04	01	H1248_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_002_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	002	0	1	04	01	H1248_002_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_002_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	002	0	1	04	01	H1248_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	002	0	1	04	01	H1248_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_003_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	003	0	1	04	01	H1248_003_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_003_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	003	0	1	04	01	H1248_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	003	0	1	04	01	H1248_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_004_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	004	0	1	04	01	H1248_004_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_004_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	004	0	1	04	01	H1248_004_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	004	0	1	04	01	H1248_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	005	0	1	04	01	H1248_005_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	005	0	1	04	01	H1248_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	005	0	1	04	01	H1248_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	006	0	1	04	01	H1248_006_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_0	5		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1248	006	0	1	04	01	H1248_006_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1248	006	0	1	04	01	H1248_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2.00	4.00	6.00																																						2.00			2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	4		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	001	0	1	01	01	H1277_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				797.12	25																																						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	4		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2.00	4.00	6.00																																						2.00			2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	4		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1277	002	0	1	01	01	H1277_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				850.73	25																																						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	001	0	1	04	01	H1278_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	001	0	1	04	01	H1278_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				527.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	003	0	1	04	01	H1278_003_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	003	0	1	04	01	H1278_003_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				393.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	4		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1278	004	0	1	04	01	H1278_004_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1278	004	0	1	04	01	H1278_004_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	004	0	1	04	01	H1278_004_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											411.00	26						259.00	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	005	0	1	04	01	H1278_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	005	0	1	04	01	H1278_005_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				328.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	007	0	1	04	01	H1278_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	007	0	1	04	01	H1278_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				427.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	009	0	1	04	01	H1278_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	009	0	1	04	01	H1278_009_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				483.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	010	0	1	04	01	H1278_010_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	010	0	1	04	01	H1278_010_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				330.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	013	0	1	04	01	H1278_013_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	013	0	1	04	01	H1278_013_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				227.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	014	0	1	04	01	H1278_014_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	014	0	1	04	01	H1278_014_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				304.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	015	0	1	04	01	H1278_015_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	015	0	1	04	01	H1278_015_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				217.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1278	016	0	1	04	01	H1278_016_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1278	016	0	1	04	01	H1278_016_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				345.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	001	0	1	01	01	H1290_001_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	001	0	1	01	01	H1290_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	001	0	1	01	01	H1290_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1120.34	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	002	0	1	01	01	H1290_002_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	002	0	1	01	01	H1290_002_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	50.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	002	0	1	01	01	H1290_002_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				833.66	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	003	0	1	01	01	H1290_003_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	003	0	1	01	01	H1290_003_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	003	0	1	01	01	H1290_003_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1109.84	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	004	0	1	01	01	H1290_004_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	004	0	1	01	01	H1290_004_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	004	0	1	01	01	H1290_004_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	004	0	1	01	01	H1290_004_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	004	0	1	01	01	H1290_004_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	8.00	16.00	24.00																			8.00	16.00	20.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	004	0	1	01	01	H1290_004_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	004	0	1	01	01	H1290_004_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1348.08	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	005	0	1	01	01	H1290_005_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	8		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	005	0	1	01	01	H1290_005_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	30.00	60.00	90.00																			30.00	60.00	75.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	005	0	1	01	01	H1290_005_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1125.98	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	006	0	1	01	01	H1290_006_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	006	0	1	01	01	H1290_006_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	006	0	1	01	01	H1290_006_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	006	0	1	01	01	H1290_006_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	006	0	1	01	01	H1290_006_0	7		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				41.58	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	006	0	1	01	01	H1290_006_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				78.86	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	006	0	1	01	01	H1290_006_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				694.48	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	007	0	1	01	01	H1290_007_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	007	0	1	01	01	H1290_007_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	007	0	1	01	01	H1290_007_0	7		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				35.84	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	007	0	1	01	01	H1290_007_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				75.86	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	007	0	1	01	01	H1290_007_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				627.93	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	008	0	1	01	01	H1290_008_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	008	0	1	01	01	H1290_008_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	008	0	1	01	01	H1290_008_0	7		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				38.64	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	008	0	1	01	01	H1290_008_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				78.21	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	008	0	1	01	01	H1290_008_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				712.54	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	009	0	1	01	01	H1290_009_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	009	0	1	01	01	H1290_009_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	009	0	1	01	01	H1290_009_0	7		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				35.17	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	009	0	1	01	01	H1290_009_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				80.08	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	009	0	1	01	01	H1290_009_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				671.24	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_0	7		Y	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				36.15	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				74.81	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	010	0	1	01	01	H1290_010_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				708.11	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	30.00	60.00	90.00																			30.00	60.00	75.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	013	0	1	01	01	H1290_013_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				697.98	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	014	0	1	01	01	H1290_014_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				693.39	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	015	0	1	01	01	H1290_015_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				692.87	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	016	0	1	01	01	H1290_016_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	016	0	1	01	01	H1290_016_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	016	0	1	01	01	H1290_016_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	016	0	1	01	01	H1290_016_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	016	0	1	01	01	H1290_016_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				691.63	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	017	0	1	01	01	H1290_017_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	017	0	1	01	01	H1290_017_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	017	0	1	01	01	H1290_017_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	017	0	1	01	01	H1290_017_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	017	0	1	01	01	H1290_017_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				689.32	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	018	0	1	01	01	H1290_018_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				689.59	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	019	0	1	01	01	H1290_019_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	019	0	1	01	01	H1290_019_0	8		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	019	0	1	01	01	H1290_019_0	8		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	019	0	1	01	01	H1290_019_0	8		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	019	0	1	01	01	H1290_019_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				31.05	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	019	0	1	01	01	H1290_019_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				76.50	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	019	0	1	01	01	H1290_019_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				704.98	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	020	0	1	01	01	H1290_020_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	020	0	1	01	01	H1290_020_0	8		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	020	0	1	01	01	H1290_020_0	8		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	020	0	1	01	01	H1290_020_0	8		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	020	0	1	01	01	H1290_020_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				30.18	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	020	0	1	01	01	H1290_020_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				75.14	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	020	0	1	01	01	H1290_020_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				702.91	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	021	0	1	01	01	H1290_021_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	021	0	1	01	01	H1290_021_0	8		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	021	0	1	01	01	H1290_021_0	8		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	021	0	1	01	01	H1290_021_0	8		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	021	0	1	01	01	H1290_021_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				30.92	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	021	0	1	01	01	H1290_021_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				76.31	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	021	0	1	01	01	H1290_021_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				704.69	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	022	0	1	01	01	H1290_022_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	022	0	1	01	01	H1290_022_0	8		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	022	0	1	01	01	H1290_022_0	8		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	022	0	1	01	01	H1290_022_0	8		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	022	0	1	01	01	H1290_022_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				29.69	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	022	0	1	01	01	H1290_022_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				74.38	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	022	0	1	01	01	H1290_022_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				701.75	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	023	0	1	01	01	H1290_023_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	023	0	1	01	01	H1290_023_0	8		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	023	0	1	01	01	H1290_023_0	8		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	023	0	1	01	01	H1290_023_0	8		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	023	0	1	01	01	H1290_023_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				30.74	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	023	0	1	01	01	H1290_023_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				76.02	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	023	0	1	01	01	H1290_023_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				704.26	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	024	0	1	01	01	H1290_024_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	024	0	1	01	01	H1290_024_0	8		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	024	0	1	01	01	H1290_024_0	8		N	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	024	0	1	01	01	H1290_024_0	8		N	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	024	0	1	01	01	H1290_024_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				29.60	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	024	0	1	01	01	H1290_024_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31				74.22	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	024	0	1	01	01	H1290_024_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				701.51	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	025	0	1	01	01	H1290_025_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	025	0	1	01	01	H1290_025_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	025	0	1	01	01	H1290_025_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1115.35	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	026	0	1	01	01	H1290_026_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	026	0	1	01	01	H1290_026_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	026	0	1	01	01	H1290_026_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	026	0	1	01	01	H1290_026_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	026	0	1	01	01	H1290_026_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	026	0	1	01	01	H1290_026_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	026	0	1	01	01	H1290_026_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				903.52	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	027	0	1	01	01	H1290_027_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	027	0	1	01	01	H1290_027_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	30.00	60.00	90.00																			30.00	60.00	75.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	027	0	1	01	01	H1290_027_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1110.67	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	028	0	1	01	01	H1290_028_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	028	0	1	01	01	H1290_028_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	028	0	1	01	01	H1290_028_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	028	0	1	01	01	H1290_028_0	8		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	028	0	1	01	01	H1290_028_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	028	0	1	01	01	H1290_028_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	85.00	170.00	255.00																			85.00	170.00	255.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	028	0	1	01	01	H1290_028_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				900.80	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	029	0	1	01	01	H1290_029_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	029	0	1	01	01	H1290_029_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	029	0	1	01	01	H1290_029_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1106.95	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	030	0	1	01	01	H1290_030_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	030	0	1	01	01	H1290_030_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1290	030	0	1	01	01	H1290_030_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	030	0	1	01	01	H1290_030_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1290	030	0	1	01	01	H1290_030_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	030	0	1	01	01	H1290_030_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	030	0	1	01	01	H1290_030_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				898.94	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	031	0	1	01	01	H1290_031_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				696.62	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1290	032	0	1	01	01	H1290_032_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				702.89	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	004	0	1	04	01	H1304_004_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											937.73	33						937.73	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	1	1	04	01	H1304_011_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	1	1	04	01	H1304_011_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	1	1	04	01	H1304_011_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	1	1	04	01	H1304_011_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	1	1	04	01	H1304_011_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	2	1	04	01	H1304_011_2	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	2	1	04	01	H1304_011_2	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	2	1	04	01	H1304_011_2	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	2	1	04	01	H1304_011_2	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	011	2	1	04	01	H1304_011_2	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	1	1	04	01	H1304_012_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	1	1	04	01	H1304_012_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	1	1	04	01	H1304_012_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	1	1	04	01	H1304_012_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	1	1	04	01	H1304_012_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	2	1	04	01	H1304_012_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	2	1	04	01	H1304_012_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	2	1	04	01	H1304_012_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	2	1	04	01	H1304_012_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	012	2	1	04	01	H1304_012_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				12.00			0.67	0.40		0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	105.00				45.00				35.00			1.50	1.17		1.50	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	3		N	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								95.00	190.00	285.00					85.00	170.00	255.00											95.00	190.00	285.00				85.00	170.00	255.00				95.00				85.00			3.17	2.83		3.17	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	33						990.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				12.00			0.67	0.40		0.67	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					35.00	70.00	105.00											45.00	90.00	135.00				35.00	70.00	105.00				45.00				35.00			1.50	1.17		1.50	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	3		N	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								95.00	190.00	285.00					85.00	170.00	255.00											95.00	190.00	285.00				85.00	170.00	255.00				95.00				85.00			3.17	2.83		3.17	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	33						990.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				5.00			0.33	0.17		0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	3		N	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	28						990.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00				10.00				5.00			0.33	0.17		0.33	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	3		N	Non-Preferred Drug	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	28						990.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				15.00				5.00			0.50	0.17		0.50	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	3		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	30						990.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				15.00				5.00			0.50	0.17		0.50	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	3		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	30						990.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	021	0	1	01	01	H1350_021_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				0.00			0.50	0.00		0.50	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	021	0	1	01	01	H1350_021_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				6.00			0.67	0.20		0.67	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	021	0	1	01	01	H1350_021_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	021	0	1	01	01	H1350_021_0	3		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	021	0	1	01	01	H1350_021_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	29						990.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	1	1	01	01	H1350_023_1	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	1	1	01	01	H1350_023_1	2		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					6.00	12.00	18.00											15.00	30.00	45.00				6.00	12.00	18.00				15.00				6.00			0.50	0.20		0.50	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	1	1	01	01	H1350_023_1	2		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	1	1	01	01	H1350_023_1	2		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	1	1	01	01	H1350_023_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	29						990.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	2	1	01	01	H1350_023_2	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	2	1	01	01	H1350_023_2	2		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					6.00	12.00	18.00											15.00	30.00	45.00				6.00	12.00	18.00				15.00				6.00			0.50	0.20		0.50	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	2	1	01	01	H1350_023_2	2		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	2	1	01	01	H1350_023_2	2		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	023	2	1	01	01	H1350_023_2	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	29						990.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	1	1	01	01	H1350_024_1	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				3.00			0.50	0.10		0.50	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	1	1	01	01	H1350_024_1	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	1	1	01	01	H1350_024_1	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	1	1	01	01	H1350_024_1	3		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	1	1	01	01	H1350_024_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	29						990.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	2	1	01	01	H1350_024_2	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				3.00			0.50	0.10		0.50	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	2	1	01	01	H1350_024_2	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	2	1	01	01	H1350_024_2	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	2	1	01	01	H1350_024_2	3		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	2	1	01	01	H1350_024_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	29						990.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	3	1	01	01	H1350_024_3	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				3.00			0.50	0.10		0.50	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	3	1	01	01	H1350_024_3	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				10.00			0.67	0.33		0.67	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	3	1	01	01	H1350_024_3	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	3	1	01	01	H1350_024_3	3		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	024	3	1	01	01	H1350_024_3	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	29						990.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	026	0	1	01	01	H1350_026_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				10.00	20.00	30.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	026	0	1	01	01	H1350_026_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	45.00				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	026	0	1	01	01	H1350_026_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	026	0	1	01	01	H1350_026_0	4		N	Non-Preferred Brand	4	10	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				90.00			3.33	3.00		3.33	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	026	0	1	01	01	H1350_026_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											990.00	27						990.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	12		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	0.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	12		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	0.00																			10.00	20.00	0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	12		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	12		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	10		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1352	002	0	1	01	01	H1352_002_0	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	10		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1352	002	0	1	01	01	H1352_002_0	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	003	0	1	01	01	H1352_003_0	12		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	003	0	1	01	01	H1352_003_0	12		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1352	003	0	1	01	01	H1352_003_0	12		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	003	0	1	01	01	H1352_003_0	12		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1352	003	0	1	01	01	H1352_003_0	12		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	003	0	1	01	01	H1352_003_0	12		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	003	0	1	01	01	H1352_003_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	001	0	1	01	01	H1353_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	001	0	1	01	01	H1353_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	001	0	1	01	01	H1353_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	001	0	1	01	01	H1353_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	001	0	1	01	01	H1353_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	002	0	1	01	01	H1353_002_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	002	0	1	01	01	H1353_002_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	002	0	1	01	01	H1353_002_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	002	0	1	01	01	H1353_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.52	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	002	0	1	01	01	H1353_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	004	0	1	01	01	H1353_004_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	004	0	1	01	01	H1353_004_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	004	0	1	01	01	H1353_004_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		92.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	004	0	1	01	01	H1353_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.33	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	004	0	1	01	01	H1353_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	005	0	1	01	01	H1353_005_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	005	0	1	01	01	H1353_005_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	005	0	1	01	01	H1353_005_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	005	0	1	01	01	H1353_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	005	0	1	01	01	H1353_005_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	006	0	1	01	01	H1353_006_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	006	0	1	01	01	H1353_006_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	006	0	1	01	01	H1353_006_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	006	0	1	01	01	H1353_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1353	006	0	1	01	01	H1353_006_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1393	001	0	1	04	01	H1393_001_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	001	0	1	04	01	H1393_001_0	5		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.32	25		25				7.32	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	001	0	1	04	01	H1393_001_0	5		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											105.36	25		25				105.36	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	001	0	1	04	01	H1393_001_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											64.92	25		25				64.92	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	001	0	1	04	01	H1393_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											584.99	25						584.99	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	001	0	1	04	01	H1393_001_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	002	0	1	04	01	H1393_002_0	7		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	002	0	1	04	01	H1393_002_0	7		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.18	25		25				7.18	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	002	0	1	04	01	H1393_002_0	7		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											103.52	25		25				103.52	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	002	0	1	04	01	H1393_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											63.38	25		25				63.38	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	002	0	1	04	01	H1393_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											574.37	25						574.37	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	002	0	1	04	01	H1393_002_0	7		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	003	0	1	04	01	H1393_003_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	003	0	1	04	01	H1393_003_0	4		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.25	25		25				7.25	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	003	0	1	04	01	H1393_003_0	4		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											104.48	25		25				104.48	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	003	0	1	04	01	H1393_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											64.24	25		25				64.24	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	003	0	1	04	01	H1393_003_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											579.96	25						579.96	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	003	0	1	04	01	H1393_003_0	4		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	004	0	1	04	01	H1393_004_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	004	0	1	04	01	H1393_004_0	5		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											6.96	25		25				6.96	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	004	0	1	04	01	H1393_004_0	5		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											105.18	25		25				105.18	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	004	0	1	04	01	H1393_004_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											58.54	25		25				58.54	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	004	0	1	04	01	H1393_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											552.98	25						552.98	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1393	004	0	1	04	01	H1393_004_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1415	021	0	1	02	01	H1415_021_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	8.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.16	48	48	48				74.55	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											759.53	33						828.87	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	8.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											96.85	48	48	48				85.24	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	024	0	1	01	01	H1415_024_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											703.62	33						681.20	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				70.16	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				70.02	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	02	01	H1416_033_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	02	01	H1416_033_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	02	01	H1416_033_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		92.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	02	01	H1416_033_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.01	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	02	01	H1416_033_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				99.02	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.13	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.2				0.2	0.2	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				96.57	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	01	01	H1416_039_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	01	01	H1416_039_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	01	01	H1416_039_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	01	01	H1416_039_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	01	01	H1416_039_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.43	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.86	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	02	01	H1416_043_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	02	01	H1416_043_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	02	01	H1416_043_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	02	01	H1416_043_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.51	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	02	01	H1416_043_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.58	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				78.33	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	055	0	1	01	01	H1416_055_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	056	0	1	01	01	H1416_056_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	056	0	1	01	01	H1416_056_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	056	0	1	01	01	H1416_056_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	056	0	1	01	01	H1416_056_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.27	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	056	0	1	01	01	H1416_056_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	057	0	1	01	01	H1416_057_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	057	0	1	01	01	H1416_057_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	057	0	1	01	01	H1416_057_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	057	0	1	01	01	H1416_057_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				77.51	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	057	0	1	01	01	H1416_057_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	064	0	1	01	01	H1416_064_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	064	0	1	01	01	H1416_064_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	064	0	1	01	01	H1416_064_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	064	0	1	01	01	H1416_064_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	064	0	1	01	01	H1416_064_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	065	0	1	01	01	H1416_065_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	065	0	1	01	01	H1416_065_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	065	0	1	01	01	H1416_065_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	065	0	1	01	01	H1416_065_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	065	0	1	01	01	H1416_065_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	066	0	1	01	01	H1416_066_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	066	0	1	01	01	H1416_066_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1416	066	0	1	01	01	H1416_066_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	066	0	1	01	01	H1416_066_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1416	066	0	1	01	01	H1416_066_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	066	0	1	01	01	H1416_066_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	066	0	1	01	01	H1416_066_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	066	0	1	01	01	H1416_066_0	5		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1416	066	0	1	01	01	H1416_066_0	5		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H1416	067	1	1	01	01	H1416_067_1	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	1	1	01	01	H1416_067_1	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	1	1	01	01	H1416_067_1	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	1	1	01	01	H1416_067_1	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				83.72	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	1	1	01	01	H1416_067_1	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	2	1	01	01	H1416_067_2	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	2	1	01	01	H1416_067_2	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	2	1	01	01	H1416_067_2	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	2	1	01	01	H1416_067_2	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				83.72	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	067	2	1	01	01	H1416_067_2	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	068	0	1	01	01	H1416_068_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	068	0	1	01	01	H1416_068_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	068	0	1	01	01	H1416_068_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	068	0	1	01	01	H1416_068_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.76	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	068	0	1	01	01	H1416_068_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	1	1	02	01	H1416_069_1	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	1	1	02	01	H1416_069_1	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	1	1	02	01	H1416_069_1	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	1	1	02	01	H1416_069_1	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	1	1	02	01	H1416_069_1	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	2	1	02	01	H1416_069_2	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	2	1	02	01	H1416_069_2	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	2	1	02	01	H1416_069_2	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	2	1	02	01	H1416_069_2	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	2	1	02	01	H1416_069_2	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	3	1	02	01	H1416_069_3	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	3	1	02	01	H1416_069_3	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	3	1	02	01	H1416_069_3	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	3	1	02	01	H1416_069_3	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	069	3	1	02	01	H1416_069_3	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1423	001	0	1	01	01	H1423_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	001	0	1	01	01	H1423_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	001	0	1	01	01	H1423_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	001	0	1	01	01	H1423_001_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	002	0	1	01	01	H1423_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	002	0	1	01	01	H1423_002_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	002	0	1	01	01	H1423_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	002	0	1	01	01	H1423_002_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	003	0	1	01	01	H1423_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	003	0	1	01	01	H1423_003_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	003	0	1	01	01	H1423_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	003	0	1	01	01	H1423_003_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	004	0	1	01	01	H1423_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	004	0	1	01	01	H1423_004_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	004	0	1	01	01	H1423_004_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	004	0	1	01	01	H1423_004_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	005	0	1	01	01	H1423_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.50	31.00	46.50					10.50	21.00	31.50					10.50	21.00	21.00																15.50				15.50			0.52	0.35	0.35			.46	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	005	0	1	01	01	H1423_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	007	0	1	01	01	H1423_007_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	007	0	1	01	01	H1423_007_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	007	0	1	01	01	H1423_007_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1423	008	0	1	01	01	H1423_008_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	008	0	1	01	01	H1423_008_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1423	008	0	1	01	01	H1423_008_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1423	008	0	1	01	01	H1423_008_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1426	001	0	1	01	01	H1426_001_0	5		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	5		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1426	001	0	1	01	01	H1426_001_0	5		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	7.00		14.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	5		N	Generic	4	01	3	2	2	3	110		01	100		1	30		90				2	2			90				30		31	7.00		14.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1426	001	0	1	01	01	H1426_001_0	5		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		200.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	001	0	1	01	01	H1426_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				533.34	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1426	002	0	1	01	01	H1426_002_0	5		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	7.00		14.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		N	Generic	4	01	3	2	2	3	110		01	100		1	30		90				2	2			90				30		31	7.00		14.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1426	002	0	1	01	01	H1426_002_0	5		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		200.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	002	0	1	01	01	H1426_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				539.50	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	5		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	5		N	Generic	4	01	3	1	2	1	110		01	100		1	30		90				2	2			90				30		31				12.17	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	5		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				101.39	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				55.99	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1426	003	0	1	01	01	H1426_003_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				631.89	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1436	002	0	1	01	01	H1436_002_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	002	0	1	01	01	H1436_002_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	004	0	1	01	01	H1436_004_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1436	005	0	1	01	01	H1436_005_0	3		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1436	005	0	1	01	01	H1436_005_0	3		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1436	005	0	1	01	01	H1436_005_0	3		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1436	005	0	1	01	01	H1436_005_0	3		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				84.00	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1436	005	0	1	01	01	H1436_005_0	3		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				68.77	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.18	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				53.54	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				52.81	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				55.36	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	12		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	12		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	12		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	12		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				56.82	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	12		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.28	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				63.51	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				81.91	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	021	0	1	01	01	H1463_021_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				56.18	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	022	0	1	02	01	H1463_022_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				69.26	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	023	0	1	01	01	H1463_023_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	12		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	12		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	12		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	12		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				62.23	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	024	0	1	01	01	H1463_024_0	12		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.66	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	025	0	1	02	01	H1463_025_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				63.31	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	032	0	1	01	01	H1463_032_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	033	0	1	01	01	H1463_033_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	033	0	1	01	01	H1463_033_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	033	0	1	01	01	H1463_033_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	033	0	1	01	01	H1463_033_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				63.15	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	033	0	1	01	01	H1463_033_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	034	0	1	02	01	H1463_034_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	034	0	1	02	01	H1463_034_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	034	0	1	02	01	H1463_034_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	034	0	1	02	01	H1463_034_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				58.10	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	034	0	1	02	01	H1463_034_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				62.19	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	035	0	1	01	01	H1463_035_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	14		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	14		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	14		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	14		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				55.46	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	036	0	1	02	01	H1463_036_0	14		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	037	0	1	02	01	H1463_037_0	14		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	037	0	1	02	01	H1463_037_0	14		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	037	0	1	02	01	H1463_037_0	14		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	037	0	1	02	01	H1463_037_0	14		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				59.31	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	037	0	1	02	01	H1463_037_0	14		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	038	0	1	01	01	H1463_038_0	14		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	038	0	1	01	01	H1463_038_0	14		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	038	0	1	01	01	H1463_038_0	14		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	038	0	1	01	01	H1463_038_0	14		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				56.06	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	038	0	1	01	01	H1463_038_0	14		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	13		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	13		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	13		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	13		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				63.42	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	039	0	1	01	01	H1463_039_0	13		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	15		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	15		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	15		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	15		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				84.09	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	040	0	1	02	01	H1463_040_0	15		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	14		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	14		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	14		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	14		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				84.09	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	041	0	1	01	01	H1463_041_0	14		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	013	0	1	01	01	H1468_013_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	014	0	1	01	01	H1468_014_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	017	0	1	01	01	H1468_017_0	4		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1468	018	0	1	01	01	H1468_018_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	018	0	1	01	01	H1468_018_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	018	0	1	01	01	H1468_018_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	018	0	1	01	01	H1468_018_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	018	0	1	01	01	H1468_018_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	005	0	1	04	01	H1537_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	005	0	1	04	01	H1537_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	005	0	1	04	01	H1537_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1537	005	0	1	04	01	H1537_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	005	0	1	04	01	H1537_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	005	0	1	04	01	H1537_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				256.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1607	012	0	1	04	01	H1607_012_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	24.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1607	014	0	1	04	01	H1607_014_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	014	0	1	04	01	H1607_014_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	014	0	1	04	01	H1607_014_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	014	0	1	04	01	H1607_014_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	014	0	1	04	01	H1607_014_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	014	0	1	04	01	H1607_014_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	014	0	1	04	01	H1607_014_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1607	015	0	1	04	01	H1607_015_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	015	0	1	04	01	H1607_015_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1608	001	0	1	04	01	H1608_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	001	0	1	04	01	H1608_001_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	001	0	1	04	01	H1608_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	001	0	1	04	01	H1608_001_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	001	0	1	04	01	H1608_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	001	0	1	04	01	H1608_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	001	0	1	04	01	H1608_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											750.64	33						476.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	004	0	1	04	01	H1608_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	004	0	1	04	01	H1608_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	004	0	1	04	01	H1608_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	004	0	1	04	01	H1608_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	004	0	1	04	01	H1608_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	004	0	1	04	01	H1608_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	004	0	1	04	01	H1608_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											750.87	33						497.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	007	0	1	04	01	H1608_007_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	007	0	1	04	01	H1608_007_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	007	0	1	04	01	H1608_007_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	007	0	1	04	01	H1608_007_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	007	0	1	04	01	H1608_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	007	0	1	04	01	H1608_007_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	007	0	1	04	01	H1608_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											757.46	33						555.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	008	0	1	04	01	H1608_008_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	008	0	1	04	01	H1608_008_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	008	0	1	04	01	H1608_008_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	008	0	1	04	01	H1608_008_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	008	0	1	04	01	H1608_008_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	008	0	1	04	01	H1608_008_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	008	0	1	04	01	H1608_008_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											666.65	33						404.51	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	012	0	1	04	01	H1608_012_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	012	0	1	04	01	H1608_012_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	012	0	1	04	01	H1608_012_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	012	0	1	04	01	H1608_012_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	012	0	1	04	01	H1608_012_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	012	0	1	04	01	H1608_012_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	012	0	1	04	01	H1608_012_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											765.62	33						558.15	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	013	0	1	04	01	H1608_013_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	013	0	1	04	01	H1608_013_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	013	0	1	04	01	H1608_013_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	013	0	1	04	01	H1608_013_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	013	0	1	04	01	H1608_013_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	013	0	1	04	01	H1608_013_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	013	0	1	04	01	H1608_013_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											783.27	29						549.54	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	016	0	1	04	01	H1608_016_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	016	0	1	04	01	H1608_016_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	016	0	1	04	01	H1608_016_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	016	0	1	04	01	H1608_016_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	016	0	1	04	01	H1608_016_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	016	0	1	04	01	H1608_016_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	016	0	1	04	01	H1608_016_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											715.47	33						459.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	017	0	1	04	01	H1608_017_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	017	0	1	04	01	H1608_017_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	017	0	1	04	01	H1608_017_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	017	0	1	04	01	H1608_017_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	017	0	1	04	01	H1608_017_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	017	0	1	04	01	H1608_017_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	017	0	1	04	01	H1608_017_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											763.68	33						331.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	018	0	1	04	01	H1608_018_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	018	0	1	04	01	H1608_018_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	018	0	1	04	01	H1608_018_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	018	0	1	04	01	H1608_018_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	018	0	1	04	01	H1608_018_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	018	0	1	04	01	H1608_018_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	018	0	1	04	01	H1608_018_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											737.74	33						412.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	021	0	1	04	01	H1608_021_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	021	0	1	04	01	H1608_021_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	021	0	1	04	01	H1608_021_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	021	0	1	04	01	H1608_021_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	021	0	1	04	01	H1608_021_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	021	0	1	04	01	H1608_021_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	021	0	1	04	01	H1608_021_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											785.14	33						425.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	024	0	1	04	01	H1608_024_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	024	0	1	04	01	H1608_024_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	024	0	1	04	01	H1608_024_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	024	0	1	04	01	H1608_024_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	024	0	1	04	01	H1608_024_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	024	0	1	04	01	H1608_024_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	024	0	1	04	01	H1608_024_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											662.68	33						447.53	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	026	0	1	04	01	H1608_026_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1608	026	0	1	04	01	H1608_026_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1608	026	0	1	04	01	H1608_026_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1608	026	0	1	04	01	H1608_026_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1608	026	0	1	04	01	H1608_026_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	026	0	1	04	01	H1608_026_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	026	0	1	04	01	H1608_026_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											683.29	33						548.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	027	0	1	04	01	H1608_027_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1608	027	0	1	04	01	H1608_027_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1608	027	0	1	04	01	H1608_027_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1608	027	0	1	04	01	H1608_027_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1608	027	0	1	04	01	H1608_027_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	027	0	1	04	01	H1608_027_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	027	0	1	04	01	H1608_027_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											658.05	33						411.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	028	0	1	04	01	H1608_028_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	028	0	1	04	01	H1608_028_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	028	0	1	04	01	H1608_028_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	028	0	1	04	01	H1608_028_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	028	0	1	04	01	H1608_028_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	028	0	1	04	01	H1608_028_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	028	0	1	04	01	H1608_028_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											798.06	29						403.80	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	029	0	1	04	01	H1608_029_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	029	0	1	04	01	H1608_029_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	029	0	1	04	01	H1608_029_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	21.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	029	0	1	04	01	H1608_029_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	21.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	029	0	1	04	01	H1608_029_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	029	0	1	04	01	H1608_029_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	029	0	1	04	01	H1608_029_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											855.38	30						422.26	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	031	0	1	04	01	H1608_031_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	031	0	1	04	01	H1608_031_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	031	0	1	04	01	H1608_031_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	031	0	1	04	01	H1608_031_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	031	0	1	04	01	H1608_031_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	031	0	1	04	01	H1608_031_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	031	0	1	04	01	H1608_031_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											646.00	29						440.69	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	035	0	1	04	01	H1608_035_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	035	0	1	04	01	H1608_035_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	035	0	1	04	01	H1608_035_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	035	0	1	04	01	H1608_035_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	035	0	1	04	01	H1608_035_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	035	0	1	04	01	H1608_035_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	035	0	1	04	01	H1608_035_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											604.33	30						419.90	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	037	0	1	04	01	H1608_037_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	037	0	1	04	01	H1608_037_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	037	0	1	04	01	H1608_037_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	037	0	1	04	01	H1608_037_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	037	0	1	04	01	H1608_037_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	037	0	1	04	01	H1608_037_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	037	0	1	04	01	H1608_037_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											720.55	33						494.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	038	0	1	04	01	H1608_038_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	038	0	1	04	01	H1608_038_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	038	0	1	04	01	H1608_038_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	038	0	1	04	01	H1608_038_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	038	0	1	04	01	H1608_038_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	038	0	1	04	01	H1608_038_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	038	0	1	04	01	H1608_038_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											636.51	33						490.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	039	0	1	04	01	H1608_039_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	039	0	1	04	01	H1608_039_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	039	0	1	04	01	H1608_039_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	039	0	1	04	01	H1608_039_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	039	0	1	04	01	H1608_039_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	039	0	1	04	01	H1608_039_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	039	0	1	04	01	H1608_039_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											702.91	33						442.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	040	0	1	04	01	H1608_040_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	040	0	1	04	01	H1608_040_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	040	0	1	04	01	H1608_040_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	040	0	1	04	01	H1608_040_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	040	0	1	04	01	H1608_040_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	040	0	1	04	01	H1608_040_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	040	0	1	04	01	H1608_040_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											729.85	33						520.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	041	0	1	04	01	H1608_041_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	041	0	1	04	01	H1608_041_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	041	0	1	04	01	H1608_041_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	041	0	1	04	01	H1608_041_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	041	0	1	04	01	H1608_041_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	041	0	1	04	01	H1608_041_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	041	0	1	04	01	H1608_041_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											810.66	33						559.27	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	043	0	1	04	01	H1608_043_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	043	0	1	04	01	H1608_043_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	043	0	1	04	01	H1608_043_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	043	0	1	04	01	H1608_043_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	043	0	1	04	01	H1608_043_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	043	0	1	04	01	H1608_043_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	043	0	1	04	01	H1608_043_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											738.36	33						541.27	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	047	0	1	04	01	H1608_047_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	047	0	1	04	01	H1608_047_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	047	0	1	04	01	H1608_047_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	047	0	1	04	01	H1608_047_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	047	0	1	04	01	H1608_047_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	047	0	1	04	01	H1608_047_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	047	0	1	04	01	H1608_047_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											692.43	33						496.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	048	0	1	04	01	H1608_048_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	048	0	1	04	01	H1608_048_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	048	0	1	04	01	H1608_048_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	048	0	1	04	01	H1608_048_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	048	0	1	04	01	H1608_048_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	048	0	1	04	01	H1608_048_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	048	0	1	04	01	H1608_048_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											708.76	33						436.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	050	0	1	04	01	H1608_050_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	050	0	1	04	01	H1608_050_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	050	0	1	04	01	H1608_050_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	050	0	1	04	01	H1608_050_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	050	0	1	04	01	H1608_050_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	050	0	1	04	01	H1608_050_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	050	0	1	04	01	H1608_050_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											738.63	33						471.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	051	0	1	04	01	H1608_051_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	051	0	1	04	01	H1608_051_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	051	0	1	04	01	H1608_051_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	051	0	1	04	01	H1608_051_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	051	0	1	04	01	H1608_051_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	051	0	1	04	01	H1608_051_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	051	0	1	04	01	H1608_051_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											609.94	30						423.95	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	052	0	1	04	01	H1608_052_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	052	0	1	04	01	H1608_052_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	052	0	1	04	01	H1608_052_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	052	0	1	04	01	H1608_052_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	052	0	1	04	01	H1608_052_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	052	0	1	04	01	H1608_052_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	052	0	1	04	01	H1608_052_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											663.28	33						490.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	053	0	1	04	01	H1608_053_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	053	0	1	04	01	H1608_053_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	053	0	1	04	01	H1608_053_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	053	0	1	04	01	H1608_053_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	053	0	1	04	01	H1608_053_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	053	0	1	04	01	H1608_053_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	053	0	1	04	01	H1608_053_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											708.90	33						519.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	054	0	1	04	01	H1608_054_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	054	0	1	04	01	H1608_054_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	054	0	1	04	01	H1608_054_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	054	0	1	04	01	H1608_054_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	054	0	1	04	01	H1608_054_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	054	0	1	04	01	H1608_054_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	054	0	1	04	01	H1608_054_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											729.54	33						534.48	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	055	0	1	04	01	H1608_055_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	055	0	1	04	01	H1608_055_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	055	0	1	04	01	H1608_055_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	055	0	1	04	01	H1608_055_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	055	0	1	04	01	H1608_055_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	055	0	1	04	01	H1608_055_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	055	0	1	04	01	H1608_055_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											678.31	33						503.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	056	0	1	04	01	H1608_056_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	056	0	1	04	01	H1608_056_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	056	0	1	04	01	H1608_056_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	056	0	1	04	01	H1608_056_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	056	0	1	04	01	H1608_056_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	056	0	1	04	01	H1608_056_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	056	0	1	04	01	H1608_056_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											562.54	30						422.74	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	059	0	1	04	01	H1608_059_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	059	0	1	04	01	H1608_059_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	059	0	1	04	01	H1608_059_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	059	0	1	04	01	H1608_059_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	059	0	1	04	01	H1608_059_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	059	0	1	04	01	H1608_059_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1608	059	0	1	04	01	H1608_059_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											632.99	33						474.46	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	001	0	1	01	01	H1609_001_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	001	0	1	01	01	H1609_001_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	001	0	1	01	01	H1609_001_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	001	0	1	01	01	H1609_001_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	001	0	1	01	01	H1609_001_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	001	0	1	01	01	H1609_001_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	001	0	1	01	01	H1609_001_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											825.84	33						568.20	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	009	0	1	01	01	H1609_009_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	009	0	1	01	01	H1609_009_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	009	0	1	01	01	H1609_009_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	009	0	1	01	01	H1609_009_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	009	0	1	01	01	H1609_009_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	009	0	1	01	01	H1609_009_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	009	0	1	01	01	H1609_009_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											813.95	33						555.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	016	0	1	01	01	H1609_016_0	8		Y	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	016	0	1	01	01	H1609_016_0	8		Y	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	016	0	1	01	01	H1609_016_0	8		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	016	0	1	01	01	H1609_016_0	8		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	016	0	1	01	01	H1609_016_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					0.00	0.00	0.00											47.00	94.00	141.00				0.00	0.00	0.00					47.00			47.00			1.57	0.00		1.57	0.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	016	0	1	01	01	H1609_016_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					35.00	70.00	105.00											100.00	200.00	300.00				35.00	70.00	105.00					100.00			100.00			3.33	1.17		3.33	1.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	016	0	1	01	01	H1609_016_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											898.90	33						692.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	017	0	1	01	01	H1609_017_0	7		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	017	0	1	01	01	H1609_017_0	7		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	017	0	1	01	01	H1609_017_0	7		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	017	0	1	01	01	H1609_017_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	017	0	1	01	01	H1609_017_0	7		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				572.99	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	018	0	1	01	01	H1609_018_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	018	0	1	01	01	H1609_018_0	5		Y	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	018	0	1	01	01	H1609_018_0	5		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	018	0	1	01	01	H1609_018_0	5		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	018	0	1	01	01	H1609_018_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					3.00	6.00	9.00											47.00	94.00	141.00				3.00	6.00	9.00					47.00			47.00			1.57	0.10		1.57	0.10	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	018	0	1	01	01	H1609_018_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					85.00	170.00	255.00											100.00	200.00	300.00				85.00	170.00	255.00					100.00			100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	018	0	1	01	01	H1609_018_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											899.48	33						495.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	019	0	1	01	01	H1609_019_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	019	0	1	01	01	H1609_019_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	019	0	1	01	01	H1609_019_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	019	0	1	01	01	H1609_019_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	019	0	1	01	01	H1609_019_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				639.85	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	020	0	1	01	01	H1609_020_0	3		Y	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	020	0	1	01	01	H1609_020_0	3		Y	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	020	0	1	01	01	H1609_020_0	3		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	020	0	1	01	01	H1609_020_0	3		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	020	0	1	01	01	H1609_020_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	020	0	1	01	01	H1609_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	020	0	1	01	01	H1609_020_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											834.48	33						452.87	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	021	0	1	01	01	H1609_021_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	021	0	1	01	01	H1609_021_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	021	0	1	01	01	H1609_021_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	021	0	1	01	01	H1609_021_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	021	0	1	01	01	H1609_021_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	021	0	1	01	01	H1609_021_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	021	0	1	01	01	H1609_021_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											848.84	33						532.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	022	0	1	01	01	H1609_022_0	4		Y	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	022	0	1	01	01	H1609_022_0	4		Y	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	022	0	1	01	01	H1609_022_0	4		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	022	0	1	01	01	H1609_022_0	4		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	022	0	1	01	01	H1609_022_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	022	0	1	01	01	H1609_022_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	022	0	1	01	01	H1609_022_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											814.25	33						427.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	023	0	1	01	01	H1609_023_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	023	0	1	01	01	H1609_023_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	023	0	1	01	01	H1609_023_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	023	0	1	01	01	H1609_023_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	023	0	1	01	01	H1609_023_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				552.53	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	025	0	1	01	01	H1609_025_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	025	0	1	01	01	H1609_025_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	025	0	1	01	01	H1609_025_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	025	0	1	01	01	H1609_025_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	025	0	1	01	01	H1609_025_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	025	0	1	01	01	H1609_025_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	025	0	1	01	01	H1609_025_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											862.23	33						517.16	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	026	0	1	01	01	H1609_026_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	026	0	1	01	01	H1609_026_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	026	0	1	01	01	H1609_026_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	026	0	1	01	01	H1609_026_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	026	0	1	01	01	H1609_026_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	026	0	1	01	01	H1609_026_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	026	0	1	01	01	H1609_026_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											990.40	33						569.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	027	0	1	01	01	H1609_027_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	027	0	1	01	01	H1609_027_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	027	0	1	01	01	H1609_027_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	027	0	1	01	01	H1609_027_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	027	0	1	01	01	H1609_027_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	027	0	1	01	01	H1609_027_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	027	0	1	01	01	H1609_027_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											871.36	33						501.16	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	028	0	1	02	01	H1609_028_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	028	0	1	02	01	H1609_028_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	028	0	1	02	01	H1609_028_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	028	0	1	02	01	H1609_028_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	028	0	1	02	01	H1609_028_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	028	0	1	02	01	H1609_028_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	028	0	1	02	01	H1609_028_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											619.78	29						494.05	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	034	0	1	01	01	H1609_034_0	3		Y	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	034	0	1	01	01	H1609_034_0	3		Y	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	034	0	1	01	01	H1609_034_0	3		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	034	0	1	01	01	H1609_034_0	3		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	034	0	1	01	01	H1609_034_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	034	0	1	01	01	H1609_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	034	0	1	01	01	H1609_034_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											912.95	33						476.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	035	0	1	01	01	H1609_035_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	035	0	1	01	01	H1609_035_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	035	0	1	01	01	H1609_035_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	035	0	1	01	01	H1609_035_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	035	0	1	01	01	H1609_035_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	035	0	1	01	01	H1609_035_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	035	0	1	01	01	H1609_035_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											857.85	33						559.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	037	0	1	01	01	H1609_037_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	037	0	1	01	01	H1609_037_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	037	0	1	01	01	H1609_037_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	037	0	1	01	01	H1609_037_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	037	0	1	01	01	H1609_037_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	037	0	1	01	01	H1609_037_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	037	0	1	01	01	H1609_037_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											868.77	33						536.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	038	0	1	01	01	H1609_038_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	038	0	1	01	01	H1609_038_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	038	0	1	01	01	H1609_038_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	038	0	1	01	01	H1609_038_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	038	0	1	01	01	H1609_038_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	038	0	1	01	01	H1609_038_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	038	0	1	01	01	H1609_038_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											851.12	33						530.64	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	039	0	1	01	01	H1609_039_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	039	0	1	01	01	H1609_039_0	4		N	Preferred Generic	4	01	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	039	0	1	01	01	H1609_039_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	039	0	1	01	01	H1609_039_0	4		N	Generic	4	01	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	039	0	1	01	01	H1609_039_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	039	0	1	01	01	H1609_039_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	039	0	1	01	01	H1609_039_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				550.53	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	040	0	1	01	01	H1609_040_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	040	0	1	01	01	H1609_040_0	4		N	Preferred Generic	4	01	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	040	0	1	01	01	H1609_040_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	040	0	1	01	01	H1609_040_0	4		N	Generic	4	01	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	040	0	1	01	01	H1609_040_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	040	0	1	01	01	H1609_040_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	040	0	1	01	01	H1609_040_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				568.40	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	041	0	1	01	01	H1609_041_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	041	0	1	01	01	H1609_041_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	041	0	1	01	01	H1609_041_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	041	0	1	01	01	H1609_041_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	041	0	1	01	01	H1609_041_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	041	0	1	01	01	H1609_041_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	041	0	1	01	01	H1609_041_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											835.46	33						522.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	042	0	1	01	01	H1609_042_0	3		Y	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	042	0	1	01	01	H1609_042_0	3		Y	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	042	0	1	01	01	H1609_042_0	3		Y	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	042	0	1	01	01	H1609_042_0	3		Y	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	042	0	1	01	01	H1609_042_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	042	0	1	01	01	H1609_042_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00					100.00			100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	042	0	1	01	01	H1609_042_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											852.44	33						439.13	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	043	0	1	01	01	H1609_043_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	043	0	1	01	01	H1609_043_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	043	0	1	01	01	H1609_043_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	043	0	1	01	01	H1609_043_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	043	0	1	01	01	H1609_043_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				593.11	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	044	0	1	01	01	H1609_044_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	044	0	1	01	01	H1609_044_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	044	0	1	01	01	H1609_044_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	044	0	1	01	01	H1609_044_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	044	0	1	01	01	H1609_044_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				591.49	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	045	0	1	01	01	H1609_045_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	045	0	1	01	01	H1609_045_0	4		N	Preferred Generic	4	01	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	045	0	1	01	01	H1609_045_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	045	0	1	01	01	H1609_045_0	4		N	Generic	4	01	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	045	0	1	01	01	H1609_045_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	045	0	1	01	01	H1609_045_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	045	0	1	01	01	H1609_045_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				554.06	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	046	0	1	01	01	H1609_046_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	046	0	1	01	01	H1609_046_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	046	0	1	01	01	H1609_046_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	046	0	1	01	01	H1609_046_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	046	0	1	01	01	H1609_046_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				574.13	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	047	0	1	01	01	H1609_047_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	047	0	1	01	01	H1609_047_0	4		N	Preferred Generic	4	01	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	047	0	1	01	01	H1609_047_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	047	0	1	01	01	H1609_047_0	4		N	Generic	4	01	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	047	0	1	01	01	H1609_047_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	047	0	1	01	01	H1609_047_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	047	0	1	01	01	H1609_047_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				593.79	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	048	0	1	01	01	H1609_048_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	048	0	1	01	01	H1609_048_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	048	0	1	01	01	H1609_048_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	048	0	1	01	01	H1609_048_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	048	0	1	01	01	H1609_048_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				585.81	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	049	0	1	01	01	H1609_049_0	4		N	Preferred Generic	4	01	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	049	0	1	01	01	H1609_049_0	4		N	Generic	4	01	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H1609	049	0	1	01	01	H1609_049_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	049	0	1	01	01	H1609_049_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	049	0	1	01	01	H1609_049_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				623.76	28																				28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	053	0	1	01	01	H1609_053_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	053	0	1	01	01	H1609_053_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	053	0	1	01	01	H1609_053_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	053	0	1	01	01	H1609_053_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	053	0	1	01	01	H1609_053_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	053	0	1	01	01	H1609_053_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1609	053	0	1	01	01	H1609_053_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											869.33	33						628.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1610	001	0	1	01	01	H1610_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1610	001	0	1	01	01	H1610_001_0	6		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1610	001	0	1	01	01	H1610_001_0	6		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.71	25	25	25				29.19	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1610	001	0	1	01	01	H1610_001_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											53.34	35	35	35				46.76	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1610	001	0	1	01	01	H1610_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											451.30	29						357.12	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1659	002	0	1	04	01	H1659_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1659	002	0	1	04	01	H1659_002_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				293.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1659	003	0	1	04	01	H1659_003_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				264.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	5		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	5		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	013	0	1	01	01	H1660_013_0	5		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	5		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1615.00	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	014	0	1	01	01	H1660_014_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	014	0	1	01	01	H1660_014_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	014	0	1	01	01	H1660_014_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	014	0	1	01	01	H1660_014_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	014	0	1	01	01	H1660_014_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	014	0	1	01	01	H1660_014_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1495.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	015	0	1	01	01	H1660_015_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	015	0	1	01	01	H1660_015_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	015	0	1	01	01	H1660_015_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	015	0	1	01	01	H1660_015_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	015	0	1	01	01	H1660_015_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	015	0	1	01	01	H1660_015_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1495.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	1	1	01	01	H1660_016_1	5		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	1	1	01	01	H1660_016_1	5		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	016	1	1	01	01	H1660_016_1	5		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	1	1	01	01	H1660_016_1	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	1	1	01	01	H1660_016_1	5		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	1	1	01	01	H1660_016_1	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1555.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	2	1	01	01	H1660_016_2	5		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	2	1	01	01	H1660_016_2	5		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	016	2	1	01	01	H1660_016_2	5		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	2	1	01	01	H1660_016_2	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	2	1	01	01	H1660_016_2	5		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	016	2	1	01	01	H1660_016_2	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1555.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	1	1	01	01	H1660_017_1	5		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	1	1	01	01	H1660_017_1	5		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	017	1	1	01	01	H1660_017_1	5		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	1	1	01	01	H1660_017_1	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	1	1	01	01	H1660_017_1	5		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	1	1	01	01	H1660_017_1	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1975.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	2	1	01	01	H1660_017_2	5		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	2	1	01	01	H1660_017_2	5		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	017	2	1	01	01	H1660_017_2	5		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	2	1	01	01	H1660_017_2	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	2	1	01	01	H1660_017_2	5		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	017	2	1	01	01	H1660_017_2	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1975.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	018	0	1	02	01	H1660_018_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	018	0	1	02	01	H1660_018_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	018	0	1	02	01	H1660_018_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	018	0	1	02	01	H1660_018_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	018	0	1	02	01	H1660_018_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	018	0	1	02	01	H1660_018_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1615.00	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1664	001	0	1	01	01	H1664_001_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1664	001	0	1	01	01	H1664_001_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					5.00	10.00	15.00					0.00	0.00	0.00																20.00				20.00			0.67	0.17	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	001	0	1	01	01	H1664_001_0	3		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1664	002	0	1	01	01	H1664_002_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1664	002	0	1	01	01	H1664_002_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					5.00	10.00	15.00					0.00	0.00	0.00																20.00				20.00			0.67	0.17	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	002	0	1	01	01	H1664_002_0	3		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1664	004	0	1	01	01	H1664_004_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1664	004	0	1	01	01	H1664_004_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					5.00	10.00	15.00					0.00	0.00	0.00																20.00				20.00			0.67	0.17	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	004	0	1	01	01	H1664_004_0	3		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1664	005	0	1	01	01	H1664_005_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	005	0	1	01	01	H1664_005_0	3		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1664	005	0	1	01	01	H1664_005_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	005	0	1	01	01	H1664_005_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	005	0	1	01	01	H1664_005_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				97.61	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	005	0	1	01	01	H1664_005_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	006	0	1	01	01	H1664_006_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	006	0	1	01	01	H1664_006_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	007	0	1	01	01	H1664_007_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	007	0	1	01	01	H1664_007_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	007	0	1	01	01	H1664_007_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.47			1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	007	0	1	01	01	H1664_007_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	007	0	1	01	01	H1664_007_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	008	0	1	01	01	H1664_008_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	008	0	1	01	01	H1664_008_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	008	0	1	01	01	H1664_008_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	008	0	1	01	01	H1664_008_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	008	0	1	01	01	H1664_008_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	008	0	1	01	01	H1664_008_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	009	0	1	01	01	H1664_009_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	009	0	1	01	01	H1664_009_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	009	0	1	01	01	H1664_009_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.47			1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	009	0	1	01	01	H1664_009_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	009	0	1	01	01	H1664_009_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	010	0	1	01	01	H1664_010_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	010	0	1	01	01	H1664_010_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					0.00	0.00	0.00																14.00				14.00			0.47	0.30	0.00			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	010	0	1	01	01	H1664_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	010	0	1	01	01	H1664_010_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	010	0	1	01	01	H1664_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	010	0	1	01	01	H1664_010_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1664	011	0	1	01	01	H1664_011_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	011	0	1	01	01	H1664_011_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	011	0	1	01	01	H1664_011_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.47			1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	011	0	1	01	01	H1664_011_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1664	011	0	1	01	01	H1664_011_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1666	001	0	1	04	01	H1666_001_0	7		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	7		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												27		27					27		27												27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1666	002	0	1	04	01	H1666_002_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												27		27					27		27												27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1666	003	0	1	04	01	H1666_003_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												27		27					27		27												27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1666	004	0	1	04	01	H1666_004_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1666	005	0	1	04	01	H1666_005_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1666	006	0	1	04	01	H1666_006_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1666	008	0	1	04	01	H1666_008_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												26		26					26		26												26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1666	010	0	1	04	01	H1666_010_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1666	010	0	1	04	01	H1666_010_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												26		26					26		26												26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	002	0	1	01	01	H1692_002_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	002	0	1	01	01	H1692_002_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	002	0	1	01	01	H1692_002_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	002	0	1	01	01	H1692_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	002	0	1	01	01	H1692_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	002	0	1	01	01	H1692_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											714.86	33						506.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	003	0	1	01	01	H1692_003_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	003	0	1	01	01	H1692_003_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	003	0	1	01	01	H1692_003_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	003	0	1	01	01	H1692_003_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	003	0	1	01	01	H1692_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	003	0	1	01	01	H1692_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	003	0	1	01	01	H1692_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											863.39	33						626.13	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	004	0	1	01	01	H1692_004_0	3		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	004	0	1	01	01	H1692_004_0	3		N	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	3.00	6.00	0.00																			3.00	6.00	0.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	004	0	1	01	01	H1692_004_0	3		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	004	0	1	01	01	H1692_004_0	3		N	Generic	4	01	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	7.00	14.00	0.00																			7.00	14.00	0.00																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	004	0	1	01	01	H1692_004_0	3		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	004	0	1	01	01	H1692_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	004	0	1	01	01	H1692_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				607.70	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	005	0	1	01	01	H1692_005_0	4		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	005	0	1	01	01	H1692_005_0	4		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	005	0	1	01	01	H1692_005_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	005	0	1	01	01	H1692_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1692	005	0	1	01	01	H1692_005_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				485.39	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H1722	002	0	1	01	01	H1722_002_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1722	002	0	1	01	01	H1722_002_0	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	10.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1722	002	0	1	01	01	H1722_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	47.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1722	002	0	1	01	01	H1722_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	100.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1722	002	0	1	01	01	H1722_002_0	9		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1723	001	0	1	48	05	H1723_001_0	3			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1723	001	0	1	48	05	H1723_001_0	3			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1723	001	0	1	48	05	H1723_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1732	001	0	1	01	01	H1732_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1732	001	0	1	01	01	H1732_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								6.00	12.00	18.00					6.00	12.00	18.00					6.00	18.00	18.00																6.00				6.00			0.20	0.20	0.20			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	001	0	1	01	01	H1732_001_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1732	002	0	1	01	01	H1732_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	002	0	1	01	01	H1732_002_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1732	002	0	1	01	01	H1732_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								6.00	12.00	18.00					6.00	12.00	18.00					6.00	18.00	18.00																6.00				6.00			0.20	0.20	0.20			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	002	0	1	01	01	H1732_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	002	0	1	01	01	H1732_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	002	0	1	01	01	H1732_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	002	0	1	01	01	H1732_002_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	002	0	1	01	01	H1732_002_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1732	003	0	1	01	01	H1732_003_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H1732	003	0	1	01	01	H1732_003_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	003	0	1	01	01	H1732_003_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1732	004	0	1	01	01	H1732_004_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	004	0	1	01	01	H1732_004_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1732	005	0	1	01	01	H1732_005_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	005	0	1	01	01	H1732_005_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	005	0	1	01	01	H1732_005_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	005	0	1	01	01	H1732_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	005	0	1	01	01	H1732_005_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	005	0	1	01	01	H1732_005_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	005	0	1	01	01	H1732_005_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1732	006	0	1	01	01	H1732_006_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	006	0	1	01	01	H1732_006_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	006	0	1	01	01	H1732_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	006	0	1	01	01	H1732_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	006	0	1	01	01	H1732_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	006	0	1	01	01	H1732_006_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1732	006	0	1	01	01	H1732_006_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1737	001	0	1	01	01	H1737_001_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	10		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				72.28	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1748	001	0	1	01	01	H1748_001_0	6		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	44.00		132.00																					132.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	001	0	1	01	01	H1748_001_0	6		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1100.34	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1748	003	0	1	01	01	H1748_003_0	5		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	003	0	1	01	01	H1748_003_0	5		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		45.00																					45.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	003	0	1	01	01	H1748_003_0	5		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	003	0	1	01	01	H1748_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	003	0	1	01	01	H1748_003_0	5		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1056.17	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	003	0	1	01	01	H1748_003_0	5		N	Select Care Drugs	4	11	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	004	0	1	01	01	H1748_004_0	5		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	004	0	1	01	01	H1748_004_0	5		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		45.00																					45.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	004	0	1	01	01	H1748_004_0	5		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	004	0	1	01	01	H1748_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	004	0	1	01	01	H1748_004_0	5		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1047.70	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1748	004	0	1	01	01	H1748_004_0	5		N	Select Care Drugs	4	11	1	1	6	1	110		01	100		1	30		90				2	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1774	001	0	1	04	01	H1774_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1787	002	0	1	01	01	H1787_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1787	002	0	1	01	01	H1787_002_0	5		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1787	002	0	1	01	01	H1787_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1787	002	0	1	01	01	H1787_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1787	002	0	1	01	01	H1787_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1821	001	0	1	04	01	H1821_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	001	0	1	04	01	H1821_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				221.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1821	002	0	1	04	01	H1821_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	002	0	1	04	01	H1821_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				328.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1821	003	0	1	04	01	H1821_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1821	003	0	1	04	01	H1821_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	6		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1846	004	0	1	04	01	H1846_004_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	001	0	1	04	01	H1848_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	001	0	1	04	01	H1848_001_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H1848	001	0	1	04	01	H1848_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	001	0	1	04	01	H1848_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	001	0	1	04	01	H1848_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	001	0	1	04	01	H1848_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	002	0	1	04	01	H1848_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	002	0	1	04	01	H1848_002_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H1848	002	0	1	04	01	H1848_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	002	0	1	04	01	H1848_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	002	0	1	04	01	H1848_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1848	002	0	1	04	01	H1848_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1862	001	0	1	01	01	H1862_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1862	001	0	1	01	01	H1862_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1862	001	0	1	01	01	H1862_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1862	001	0	1	01	01	H1862_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.16	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1862	001	0	1	01	01	H1862_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1894	001	0	1	01	01	H1894_001_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1894	002	0	1	01	01	H1894_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1894	002	0	1	01	01	H1894_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								6.00	12.00	18.00					6.00	12.00	18.00					6.00	18.00	18.00																6.00				6.00			0.20	0.20	0.20			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1914	001	0	1	04	01	H1914_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	001	0	1	04	01	H1914_001_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1914	001	0	1	04	01	H1914_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	001	0	1	04	01	H1914_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	001	0	1	04	01	H1914_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.16	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	001	0	1	04	01	H1914_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	002	0	1	04	01	H1914_002_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	002	0	1	04	01	H1914_002_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H1914	002	0	1	04	01	H1914_002_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	002	0	1	04	01	H1914_002_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	002	0	1	04	01	H1914_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.82	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	002	0	1	04	01	H1914_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	003	0	1	04	01	H1914_003_0	4		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	003	0	1	04	01	H1914_003_0	4		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1914	003	0	1	04	01	H1914_003_0	4		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	003	0	1	04	01	H1914_003_0	4		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1914	003	0	1	04	01	H1914_003_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	003	0	1	04	01	H1914_003_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.97	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1914	003	0	1	04	01	H1914_003_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	001	0	1	01	01	H1944_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				392.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	004	0	1	01	01	H1944_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				374.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	005	0	1	01	01	H1944_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				258.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	006	0	1	01	01	H1944_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				223.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1944	009	0	1	01	01	H1944_009_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1944	009	0	1	01	01	H1944_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				383.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	010	0	1	01	01	H1944_010_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	011	0	1	01	01	H1944_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				371.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	014	0	1	02	01	H1944_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	02	01	H1944_014_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				366.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	016	0	1	02	01	H1944_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	02	01	H1944_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	017	0	1	01	01	H1944_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				331.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	018	0	1	01	01	H1944_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				284.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	024	0	1	01	01	H1944_024_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				470.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	028	0	1	01	01	H1944_028_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	028	0	1	01	01	H1944_028_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				299.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	01	01	H1944_031_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	01	01	H1944_031_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	01	01	H1944_031_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	031	0	1	01	01	H1944_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	01	01	H1944_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	031	0	1	01	01	H1944_031_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				489.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	01	01	H1944_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	01	01	H1944_032_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	01	01	H1944_032_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H1944	032	0	1	01	01	H1944_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	01	01	H1944_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	032	0	1	01	01	H1944_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				314.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1947	001	0	1	01	01	H1947_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1947	001	0	1	01	01	H1947_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								44.00	88.00	132.00					44.00	88.00	132.00					44.00	132.00	132.00																44.00				44.00			1.47	1.47	1.47			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1947	001	0	1	01	01	H1947_001_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1951	013	0	1	01	01	H1951_013_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	044	0	1	01	01	H1951_044_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	2		Y	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	2		Y	Generic	4	11	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1951	044	0	1	01	01	H1951_044_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	2		Y	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	2		Y	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	2		Y	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												15							15												15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	2		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	2		Y	Select Care Drugs	4	11	1	2	6	3		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1951	047	1	1	01	01	H1951_047_1	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	1	1	01	01	H1951_049_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	2	1	01	01	H1951_049_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	049	3	1	01	01	H1951_049_3	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	051	0	1	01	01	H1951_051_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	052	0	1	01	01	H1951_052_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	6		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	6		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	6		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	1	1	01	01	H1961_014_1	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				295.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	2	1	01	01	H1961_014_2	6		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	2	1	01	01	H1961_014_2	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				295.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	01	01	H1961_014_3	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	01	01	H1961_014_3	6		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	3	1	01	01	H1961_014_3	6		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	01	01	H1961_014_3	6		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	3	1	01	01	H1961_014_3	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	01	01	H1961_014_3	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	3	1	01	01	H1961_014_3	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				295.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	01	01	H1961_014_4	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	01	01	H1961_014_4	6		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	014	4	1	01	01	H1961_014_4	6		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	01	01	H1961_014_4	6		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	014	4	1	01	01	H1961_014_4	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	01	01	H1961_014_4	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	014	4	1	01	01	H1961_014_4	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				295.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	017	0	1	01	01	H1961_017_0	6		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	6		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	017	0	1	01	01	H1961_017_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				396.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	018	0	1	01	01	H1961_018_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	018	0	1	01	01	H1961_018_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1961	018	0	1	01	01	H1961_018_0	6		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	018	0	1	01	01	H1961_018_0	6		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1961	018	0	1	01	01	H1961_018_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	018	0	1	01	01	H1961_018_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1961	018	0	1	01	01	H1961_018_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				226.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	004	0	1	01	01	H1969_004_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	004	0	1	01	01	H1969_004_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	004	0	1	01	01	H1969_004_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	004	0	1	01	01	H1969_004_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	004	0	1	01	01	H1969_004_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	3	1	01	01	H1969_007_3	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	3	1	01	01	H1969_007_3	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	3	1	01	01	H1969_007_3	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	3	1	01	01	H1969_007_3	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	3	1	01	01	H1969_007_3	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	4	1	01	01	H1969_007_4	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	4	1	01	01	H1969_007_4	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	4	1	01	01	H1969_007_4	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	4	1	01	01	H1969_007_4	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	007	4	1	01	01	H1969_007_4	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	1	1	01	01	H1969_008_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	1	1	01	01	H1969_008_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	1	1	01	01	H1969_008_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	1	1	01	01	H1969_008_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	1	1	01	01	H1969_008_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	2	1	01	01	H1969_008_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	2	1	01	01	H1969_008_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	2	1	01	01	H1969_008_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	2	1	01	01	H1969_008_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1969	008	2	1	01	01	H1969_008_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1977	001	0	1	48	05	H1977_001_0	2			Generic Drugs	4	01			1	1	010		01			1	30														30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
H1977	001	0	1	48	05	H1977_001_0	2			Brand Drugs	4	10			2	1	010		01			1	30														30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
H1993	001	0	1	01	01	H1993_001_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	001	0	1	01	01	H1993_001_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1993	001	0	1	01	01	H1993_001_0	9		N	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	001	0	1	01	01	H1993_001_0	9		N	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1993	001	0	1	01	01	H1993_001_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	32.00	64.00	96.00																			32.00	64.00	64.00																32.00				32.00		1.07			1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	001	0	1	01	01	H1993_001_0	9		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	001	0	1	01	01	H1993_001_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				950.37	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	002	0	1	01	01	H1993_002_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	002	0	1	01	01	H1993_002_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1993	002	0	1	01	01	H1993_002_0	7		N	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	002	0	1	01	01	H1993_002_0	7		N	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1993	002	0	1	01	01	H1993_002_0	7		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				92.98	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	002	0	1	01	01	H1993_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				71.29	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	002	0	1	01	01	H1993_002_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				663.23	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	003	0	1	01	01	H1993_003_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	003	0	1	01	01	H1993_003_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1993	003	0	1	01	01	H1993_003_0	6		N	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	003	0	1	01	01	H1993_003_0	6		N	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1993	003	0	1	01	01	H1993_003_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	32.00	64.00	96.00																			32.00	64.00	64.00																32.00				32.00		1.07			1.07			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	003	0	1	01	01	H1993_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	003	0	1	01	01	H1993_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				952.48	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	004	0	1	01	01	H1993_004_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	004	0	1	01	01	H1993_004_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1993	004	0	1	01	01	H1993_004_0	6		N	Generic	4	01	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	004	0	1	01	01	H1993_004_0	6		N	Generic	4	01	3	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1993	004	0	1	01	01	H1993_004_0	6		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				92.87	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	004	0	1	01	01	H1993_004_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				70.79	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1993	004	0	1	01	01	H1993_004_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				663.62	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	6		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	001	0	1	01	01	H1994_001_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	6		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	001	0	1	01	01	H1994_001_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	6		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1246.68	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	6		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	002	0	1	01	01	H1994_002_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	6		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	002	0	1	01	01	H1994_002_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	6		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1153.37	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	003	0	1	01	01	H1994_003_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	003	0	1	01	01	H1994_003_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1220.70	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	004	0	1	01	01	H1994_004_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	004	0	1	01	01	H1994_004_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1254.22	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	6		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1994	007	0	1	01	01	H1994_007_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	6		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	007	0	1	01	01	H1994_007_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	6		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1252.66	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	6		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	6		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	008	0	1	01	01	H1994_008_0	6		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	6		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	008	0	1	01	01	H1994_008_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	6		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1490.47	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1994	012	0	1	01	01	H1994_012_0	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	5		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	012	0	1	01	01	H1994_012_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				2229.08	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	013	0	1	01	01	H1994_013_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	7		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	013	0	1	01	01	H1994_013_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	013	0	1	01	01	H1994_013_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1220.70	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	014	0	1	01	01	H1994_014_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	7		Y	Generic	4	11	1	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
H1994	014	0	1	01	01	H1994_014_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	014	0	1	01	01	H1994_014_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1254.22	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	009	0	1	01	01	H1997_009_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	009	0	1	01	01	H1997_009_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	009	0	1	01	01	H1997_009_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	009	0	1	01	01	H1997_009_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	009	0	1	01	01	H1997_009_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											795.65	28						795.65	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	010	0	1	01	01	H1997_010_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	010	0	1	01	01	H1997_010_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	010	0	1	01	01	H1997_010_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	010	0	1	01	01	H1997_010_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	010	0	1	01	01	H1997_010_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											795.65	28						795.65	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	011	0	1	01	01	H1997_011_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	011	0	1	01	01	H1997_011_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	011	0	1	01	01	H1997_011_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	011	0	1	01	01	H1997_011_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1997	011	0	1	01	01	H1997_011_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	001	0	1	04	01	H2001_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				298.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	010	0	1	04	01	H2001_010_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				413.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	017	0	1	04	01	H2001_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				351.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	018	0	1	04	01	H2001_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	018	0	1	04	01	H2001_018_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				318.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2001	019	0	1	04	01	H2001_019_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	019	0	1	04	01	H2001_019_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				334.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2011	001	0	1	01	01	H2011_001_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	001	0	1	01	01	H2011_001_0	5		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.31	25		25				7.31	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	001	0	1	01	01	H2011_001_0	5		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											105.26	25		25				105.26	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	001	0	1	01	01	H2011_001_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											64.83	25		25				64.83	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	001	0	1	01	01	H2011_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											584.31	25						584.31	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	001	0	1	01	01	H2011_001_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	002	0	1	01	01	H2011_002_0	6		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	002	0	1	01	01	H2011_002_0	6		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.17	25		25				7.17	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	002	0	1	01	01	H2011_002_0	6		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											103.42	25		25				103.42	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	002	0	1	01	01	H2011_002_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											63.29	25		25				63.29	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	002	0	1	01	01	H2011_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											573.80	25						573.80	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	002	0	1	01	01	H2011_002_0	6		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	003	0	1	01	01	H2011_003_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	003	0	1	01	01	H2011_003_0	4		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.30	25		25				7.30	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	003	0	1	01	01	H2011_003_0	4		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											105.08	25		25				105.08	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	003	0	1	01	01	H2011_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											64.74	25		25				64.74	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	003	0	1	01	01	H2011_003_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											583.52	25						583.52	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	003	0	1	01	01	H2011_003_0	4		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	004	0	1	01	01	H2011_004_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	004	0	1	01	01	H2011_004_0	4		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.16	25		25				7.16	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	004	0	1	01	01	H2011_004_0	4		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											103.26	25		25				103.26	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	004	0	1	01	01	H2011_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											63.23	25		25				63.23	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	004	0	1	01	01	H2011_004_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											573.33	25						573.33	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2011	004	0	1	01	01	H2011_004_0	4		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2020	001	0	1	04	01	H2020_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		0.00					2.00		0.00											9.00		0.00				2.00		0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		0.00					2.00		0.00											9.00		0.00				2.00		0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	001	0	1	04	01	H2020_001_0	7		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					7.00		21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7		Y	Generic	4	01	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					7.00		21.00											14.00		42.00				2.00		0.00				14.00				14.00			0.47	0.23		0.47	0.07	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	001	0	1	04	01	H2020_001_0	7		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	001	0	1	04	01	H2020_001_0	7		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												31		31					31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	6		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					2.00		6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	6		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					2.00		6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	002	0	1	04	01	H2020_002_0	6		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	6		Y	Generic	4	01	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	002	0	1	04	01	H2020_002_0	6		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	6		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	002	0	1	04	01	H2020_002_0	6		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												33		33					33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	003	0	1	04	01	H2020_003_0	7		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7		Y	Generic	4	01	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	003	0	1	04	01	H2020_003_0	7		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	003	0	1	04	01	H2020_003_0	7		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												31		31					31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		0.00					2.00		0.00											9.00		0.00				2.00		0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		0.00					2.00		0.00											9.00		0.00				2.00		0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	004	0	1	04	01	H2020_004_0	7		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					7.00		21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7		Y	Generic	4	01	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					7.00		21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	004	0	1	04	01	H2020_004_0	7		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	004	0	1	04	01	H2020_004_0	7		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												31		31					31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	6		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	6		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2020	005	0	1	04	01	H2020_005_0	6		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	6		Y	Generic	4	01	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2020	005	0	1	04	01	H2020_005_0	6		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	6		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2020	005	0	1	04	01	H2020_005_0	6		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												33		33					33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	50.00		150.00																									50.00		150.00				50.00		140.00				50.00				50.00		1.67				1.67	1.67	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	2		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2032	001	0	1	04	01	H2032_001_0	15		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	8.00																			0.00	0.00	0.00																4.00				4.00		0.13			0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	15		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	28.00																			0.00	0.00	0.00																14.00				14.00		0.47			0.00			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	15		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	15		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	198.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	001	0	1	04	01	H2032_001_0	15		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	6.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	11		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	14.00	28.00	28.00																			0.00	0.00	0.00																14.00				14.00		0.47			0.00			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	198.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	002	0	1	04	01	H2032_002_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	4.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	24.00																			0.00	0.00	0.00																12.00				12.00		0.40			0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	190.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2032	003	0	1	04	01	H2032_003_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2056	001	0	1	01	01	H2056_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	001	0	1	01	01	H2056_001_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	001	0	1	01	01	H2056_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	001	0	1	01	01	H2056_001_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	001	0	1	01	01	H2056_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	001	0	1	01	01	H2056_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	001	0	1	01	01	H2056_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											817.80	33						595.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	002	0	1	01	01	H2056_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	002	0	1	01	01	H2056_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	002	0	1	01	01	H2056_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	002	0	1	01	01	H2056_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	002	0	1	01	01	H2056_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	002	0	1	01	01	H2056_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	002	0	1	01	01	H2056_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											804.88	33						585.82	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	003	0	1	01	01	H2056_003_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	003	0	1	01	01	H2056_003_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	003	0	1	01	01	H2056_003_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	003	0	1	01	01	H2056_003_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	003	0	1	01	01	H2056_003_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	003	0	1	01	01	H2056_003_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	003	0	1	01	01	H2056_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											800.66	33						578.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	004	0	1	01	01	H2056_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	004	0	1	01	01	H2056_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	004	0	1	01	01	H2056_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	004	0	1	01	01	H2056_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	004	0	1	01	01	H2056_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	004	0	1	01	01	H2056_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	004	0	1	01	01	H2056_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											821.96	33						594.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	005	0	1	01	01	H2056_005_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	005	0	1	01	01	H2056_005_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	005	0	1	01	01	H2056_005_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	005	0	1	01	01	H2056_005_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	005	0	1	01	01	H2056_005_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	005	0	1	01	01	H2056_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	005	0	1	01	01	H2056_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											800.60	33						580.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	007	0	1	01	01	H2056_007_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	007	0	1	01	01	H2056_007_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	007	0	1	01	01	H2056_007_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	007	0	1	01	01	H2056_007_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2056	007	0	1	01	01	H2056_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	007	0	1	01	01	H2056_007_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2056	007	0	1	01	01	H2056_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											800.60	33						580.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2108	022	0	1	01	01	H2108_022_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											773.57	33						726.17	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2108	028	0	1	01	01	H2108_028_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											787.87	33						512.07	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	029	0	1	01	01	H2108_029_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											709.90	33						673.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	6		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	12.00					5.00	10.00	10.00											6.00	12.00	12.00				5.00	10.00	10.00				6.00				6.00			0.20	0.17		0.20	0.17	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											854.19	33						701.35	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	6		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	22.00					10.00	20.00	20.00											11.00	22.00	22.00				10.00	20.00	20.00				11.00				11.00			0.37	0.33		0.37	0.33	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	034	0	1	01	01	H2108_034_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	034	0	1	01	01	H2108_034_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	5.00	5.00											20.00	40.00	40.00				0.00	0.00	0.00				20.00				20.00			0.67	0.17		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	034	0	1	01	01	H2108_034_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	034	0	1	01	01	H2108_034_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	034	0	1	01	01	H2108_034_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											644.63	28						425.49	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	036	0	1	01	01	H2108_036_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	036	0	1	01	01	H2108_036_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	036	0	1	01	01	H2108_036_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	036	0	1	01	01	H2108_036_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	036	0	1	01	01	H2108_036_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											792.00	33						737.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2120	001	0	1	01	01	H2120_001_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	6.00	6.00					1.00	1.00	1.00											6.00	6.00	6.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	001	0	1	01	01	H2120_001_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	6.00	6.00					1.00	1.00	1.00											6.00	6.00	6.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2120	001	0	1	01	01	H2120_001_0	9		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	15.00	15.00					10.00	10.00	10.00											15.00	15.00	15.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	001	0	1	01	01	H2120_001_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	89.00	110.00					42.00	84.00	105.00											47.00	89.00	110.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	001	0	1	01	01	H2120_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	189.00	230.00					92.00	184.00	225.00											97.00	189.00	230.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	001	0	1	01	01	H2120_001_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	001	0	1	01	01	H2120_001_0	9		Y	Select Care Drugs	4	11	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								11.00	11.00	11.00					6.00	6.00	6.00											11.00	11.00	11.00				6.00	6.00	6.00					11.00			11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	002	0	1	01	01	H2120_002_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	6.00	6.00					1.00	1.00	1.00											6.00	6.00	6.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	002	0	1	01	01	H2120_002_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	6.00	6.00					1.00	1.00	1.00											6.00	6.00	6.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2120	002	0	1	01	01	H2120_002_0	9		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	15.00	15.00					10.00	10.00	10.00											15.00	15.00	15.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	002	0	1	01	01	H2120_002_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	89.00	110.00					42.00	84.00	105.00											47.00	89.00	110.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	002	0	1	01	01	H2120_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	189.00	230.00					92.00	184.00	225.00											97.00	189.00	230.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	002	0	1	01	01	H2120_002_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	002	0	1	01	01	H2120_002_0	9		Y	Select Care Drugs	4	11	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								11.00	11.00	11.00					6.00	6.00	6.00											11.00	11.00	11.00				6.00	6.00	6.00					11.00			11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	003	0	1	01	01	H2120_003_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	6.00	6.00					1.00	1.00	1.00											6.00	6.00	6.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	003	0	1	01	01	H2120_003_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	6.00	6.00					1.00	1.00	1.00											6.00	6.00	6.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2120	003	0	1	01	01	H2120_003_0	9		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	15.00	15.00					10.00	10.00	10.00											15.00	15.00	15.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	003	0	1	01	01	H2120_003_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	89.00	110.00					42.00	84.00	105.00											47.00	89.00	110.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	003	0	1	01	01	H2120_003_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	189.00	230.00					92.00	184.00	225.00											97.00	189.00	230.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	003	0	1	01	01	H2120_003_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	003	0	1	01	01	H2120_003_0	9		Y	Select Care Drugs	4	11	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								11.00	11.00	11.00					6.00	6.00	6.00											11.00	11.00	11.00				6.00	6.00	6.00					11.00			11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	004	0	1	01	01	H2120_004_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	6.00	6.00					1.00	1.00	1.00											6.00	6.00	6.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	004	0	1	01	01	H2120_004_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	6.00	6.00					1.00	1.00	1.00											6.00	6.00	6.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2120	004	0	1	01	01	H2120_004_0	9		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	15.00	15.00					10.00	10.00	10.00											15.00	15.00	15.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	004	0	1	01	01	H2120_004_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	89.00	110.00					42.00	84.00	105.00											47.00	89.00	110.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	004	0	1	01	01	H2120_004_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	189.00	230.00					92.00	184.00	225.00											97.00	189.00	230.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	004	0	1	01	01	H2120_004_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2120	004	0	1	01	01	H2120_004_0	9		Y	Select Care Drugs	4	11	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								11.00	11.00	11.00					6.00	6.00	6.00											11.00	11.00	11.00				6.00	6.00	6.00					11.00			11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	001	0	1	01	01	H2134_001_0	3		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	001	0	1	01	01	H2134_001_0	3		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	001	0	1	01	01	H2134_001_0	3		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	001	0	1	01	01	H2134_001_0	3		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.00	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	001	0	1	01	01	H2134_001_0	3		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	002	0	1	01	01	H2134_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	30						0.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	002	0	1	01	01	H2134_002_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	003	0	1	01	01	H2134_003_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	1.00	2.00	3.00																			1.00	2.00	2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	003	0	1	01	01	H2134_003_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	003	0	1	01	01	H2134_003_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	003	0	1	01	01	H2134_003_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				94.00	48	48	48																		48	48	48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	003	0	1	01	01	H2134_003_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	004	0	1	01	01	H2134_004_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	004	0	1	01	01	H2134_004_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	004	0	1	01	01	H2134_004_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	004	0	1	01	01	H2134_004_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				85.00	48	48	48																		48	48	48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	004	0	1	01	01	H2134_004_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2134	005	0	1	01	01	H2134_005_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	30						0.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2134	005	0	1	01	01	H2134_005_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2161	002	0	1	02	01	H2161_002_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	002	0	1	02	01	H2161_002_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	15.00	15.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	002	0	1	02	01	H2161_002_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	84.00																			42.00	63.00	63.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	002	0	1	02	01	H2161_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	190.00																			95.00	142.50	142.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	002	0	1	02	01	H2161_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	003	0	1	01	01	H2161_003_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	3.00	3.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	003	0	1	01	01	H2161_003_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	18.00	36.00	36.00																			18.00	27.00	27.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	003	0	1	01	01	H2161_003_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	47.00	94.00	94.00																			47.00	70.50	70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	003	0	1	01	01	H2161_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	100.00	200.00	200.00																			100.00	150.00	150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2161	003	0	1	01	01	H2161_003_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	001	0	1	01	01	H2162_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	001	0	1	01	01	H2162_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	001	0	1	01	01	H2162_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	001	0	1	01	01	H2162_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.88	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	001	0	1	01	01	H2162_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	002	0	1	01	01	H2162_002_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	002	0	1	01	01	H2162_002_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	002	0	1	01	01	H2162_002_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	002	0	1	01	01	H2162_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.27	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2162	002	0	1	01	01	H2162_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2171	001	0	1	01	01	H2171_001_0	7		Y	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	7		Y	Generic	4	11	1	2	2	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2171	001	0	1	01	01	H2171_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	7		Y	Preferred Brand	4	11	1	2	3	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2171	001	0	1	01	01	H2171_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	95.00	190.00	190.00																			95.00	190.00	190.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1680.34	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2172	001	0	1	01	01	H2172_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	001	0	1	01	01	H2172_001_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	6		N	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	001	0	1	01	01	H2172_001_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					80.00	160.00	240.00											100.00	200.00	300.00				80.00	160.00	160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											861.00	33	33	33				861.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	001	0	1	01	01	H2172_001_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	01	01	H2172_002_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	01	01	H2172_002_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7		N	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	002	0	1	01	01	H2172_002_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					80.00	160.00	240.00											100.00	200.00	300.00				80.00	160.00	160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											793.00	33	33	33				793.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	002	0	1	01	01	H2172_002_0	7		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	003	0	1	01	01	H2172_003_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	0.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											1027.00	33	33	33				1027.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	003	0	1	01	01	H2172_003_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	004	0	1	01	01	H2172_004_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	0.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											794.00	33	33	33				794.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	004	0	1	01	01	H2172_004_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	006	0	1	01	01	H2172_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											900.00	33	33	33				900.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	006	0	1	01	01	H2172_006_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	008	0	1	01	01	H2172_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	0.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	01	01	H2172_008_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	0.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	008	0	1	01	01	H2172_008_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	24.00				20.00				20.00			0.66	0.40		0.66	0.40	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	01	01	H2172_008_0	6		N	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	24.00				20.00				20.00			0.66	0.40		0.66	0.40	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	008	0	1	01	01	H2172_008_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	01	01	H2172_008_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					80.00	160.00	240.00											100.00	200.00	300.00				80.00	160.00	160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	01	01	H2172_008_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											747.00	33	33	33				747.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	01	01	H2172_008_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	008	0	1	01	01	H2172_008_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	009	0	1	01	01	H2172_009_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	0.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	01	01	H2172_009_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	24.00				20.00				20.00			0.66	0.40		0.66	0.40	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	01	01	H2172_009_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	01	01	H2172_009_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	01	01	H2172_009_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											643.00	33	33	33				643.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	01	01	H2172_009_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	009	0	1	01	01	H2172_009_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	010	0	1	01	01	H2172_010_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	0.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	01	01	H2172_010_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	01	01	H2172_010_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	01	01	H2172_010_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	01	01	H2172_010_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											632.00	33	33	33				632.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	01	01	H2172_010_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	010	0	1	01	01	H2172_010_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	011	0	1	01	01	H2172_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											816.00	33	33	33				816.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	011	0	1	01	01	H2172_011_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2172	012	0	1	01	01	H2172_012_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	0.00	0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	90.00				47.00				47.00			1.56	1.50		1.56	1.50	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											795.00	33	33	33				795.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	6		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2172	012	0	1	01	01	H2172_012_0	6		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2174	001	0	1	01	01	H2174_001_0	6		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2174	001	0	1	01	01	H2174_001_0	6		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2174	001	0	1	01	01	H2174_001_0	6		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2174	001	0	1	01	01	H2174_001_0	6		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.00	44	44	44																		44	44	44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2174	001	0	1	01	01	H2174_001_0	6		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2196	001	0	1	01	01	H2196_001_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	001	0	1	01	01	H2196_001_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				307.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2196	002	0	1	01	01	H2196_002_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2196	002	0	1	01	01	H2196_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				296.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	9		N	Preferred Generic	2	01	1	1	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	9		N	Generic	2	01	1	1	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	9		N	Preferred Brand	2	10	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	9		N	Non-Preferred Brand	2	11	1	1	4	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2225	001	0	1	01	01	H2225_001_0	9		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	011	0	1	04	01	H2228_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				365.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	017	0	1	04	01	H2228_017_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				231.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	018	0	1	04	01	H2228_018_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	019	0	1	04	01	H2228_019_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				374.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	020	0	1	04	01	H2228_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				279.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	021	0	1	04	01	H2228_021_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				267.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	022	0	1	04	01	H2228_022_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				396.00	32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		28.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		28.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	023	0	1	04	01	H2228_023_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				192.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	024	0	1	04	01	H2228_024_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				188.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	029	0	1	04	01	H2228_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				313.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		5.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		20.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		20.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	030	0	1	04	01	H2228_030_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				273.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	031	0	1	04	01	H2228_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	032	0	1	04	01	H2228_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				122.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	035	0	1	04	01	H2228_035_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				421.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	036	0	1	04	01	H2228_036_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				369.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2228	037	0	1	04	01	H2228_037_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2228	037	0	1	04	01	H2228_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				174.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	039	0	1	04	01	H2228_039_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				245.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	047	0	1	04	01	H2228_047_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				285.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	049	0	1	04	01	H2228_049_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				258.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	064	0	1	04	01	H2228_064_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	064	0	1	04	01	H2228_064_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				428.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	065	0	1	04	01	H2228_065_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	065	0	1	04	01	H2228_065_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				340.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	066	0	1	04	01	H2228_066_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	066	0	1	04	01	H2228_066_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				292.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	067	0	1	04	01	H2228_067_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	067	0	1	04	01	H2228_067_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				219.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	068	0	1	04	01	H2228_068_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	068	0	1	04	01	H2228_068_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				249.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	6		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	6		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	071	0	1	04	01	H2228_071_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	071	0	1	04	01	H2228_071_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				370.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	074	0	1	04	01	H2228_074_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	074	0	1	04	01	H2228_074_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											269.00	29						199.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	075	0	1	04	01	H2228_075_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	075	0	1	04	01	H2228_075_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											321.00	28						191.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	076	0	1	04	01	H2228_076_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	076	0	1	04	01	H2228_076_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				202.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	077	0	1	04	01	H2228_077_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	077	0	1	04	01	H2228_077_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											363.00	29						198.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	079	0	1	04	01	H2228_079_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	079	0	1	04	01	H2228_079_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	079	0	1	04	01	H2228_079_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	079	0	1	04	01	H2228_079_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	079	0	1	04	01	H2228_079_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	079	0	1	04	01	H2228_079_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											293.00	29						247.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	080	0	1	04	01	H2228_080_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	080	0	1	04	01	H2228_080_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				285.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	081	0	1	04	01	H2228_081_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	081	0	1	04	01	H2228_081_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				256.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	082	0	1	04	01	H2228_082_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	082	0	1	04	01	H2228_082_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				406.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	5		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	5		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	083	0	1	04	01	H2228_083_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	083	0	1	04	01	H2228_083_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											413.00	33						280.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	084	0	1	04	01	H2228_084_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	084	0	1	04	01	H2228_084_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											252.00	28						240.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	085	0	1	04	01	H2228_085_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	085	0	1	04	01	H2228_085_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				462.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	086	0	1	04	01	H2228_086_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	086	0	1	04	01	H2228_086_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				458.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	093	0	1	04	01	H2228_093_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	093	0	1	04	01	H2228_093_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				415.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	094	0	1	04	01	H2228_094_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	094	0	1	04	01	H2228_094_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				224.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	096	0	1	04	01	H2228_096_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	096	0	1	04	01	H2228_096_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											350.00	28						158.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2228	097	0	1	04	01	H2228_097_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	097	0	1	04	01	H2228_097_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											335.00	29						185.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	6		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					2.00	4.00	6.00					2.00	2.00	2.00																10.00				10.00			0.33	0.07	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	017	0	1	04	01	H2230_017_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					10.00	20.00	30.00					10.00	20.00	20.00																16.00				16.00			0.53	0.33	0.33			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	017	0	1	04	01	H2230_017_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	017	0	1	04	01	H2230_017_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	017	0	1	04	01	H2230_017_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	017	0	1	04	01	H2230_017_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	5.00	5.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	1	1	04	01	H2230_018_1	6		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					2.00	4.00	6.00					2.00	2.00	2.00																8.00				8.00			0.27	0.07	0.07			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	1	1	04	01	H2230_018_1	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					6.00	12.00	18.00					6.00	12.00	12.00																12.00				12.00			0.40	0.20	0.20			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	1	1	04	01	H2230_018_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	1	1	04	01	H2230_018_1	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	1	1	04	01	H2230_018_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	1	1	04	01	H2230_018_1	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	5.00	5.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	2	1	04	01	H2230_018_2	6		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					2.00	4.00	6.00					2.00	2.00	2.00																8.00				8.00			0.27	0.07	0.07			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	2	1	04	01	H2230_018_2	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					6.00	12.00	18.00					6.00	12.00	12.00																12.00				12.00			0.40	0.20	0.20			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	2	1	04	01	H2230_018_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	2	1	04	01	H2230_018_2	6		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	2	1	04	01	H2230_018_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2230	018	2	1	04	01	H2230_018_2	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	5.00	5.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2235	001	0	1	01	01	H2235_001_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	8		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					0.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					95.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	8		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	255.00																					245.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	001	0	1	01	01	H2235_001_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				878.24	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	8		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					0.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					125.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	8		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					275.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	002	0	1	01	01	H2235_002_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				833.69	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	8		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					95.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	8		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	255.00																					245.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	003	0	1	01	01	H2235_003_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				789.85	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	004	0	1	01	01	H2235_004_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	004	0	1	01	01	H2235_004_0	8		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	004	0	1	01	01	H2235_004_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					95.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	004	0	1	01	01	H2235_004_0	8		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	255.00																					245.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2235	004	0	1	01	01	H2235_004_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				789.85	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	7		N	Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	7		N	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	7		N	Specialty Tier	3	11	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	7		N	Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	33.00																11.00				11.00		0.37			0.37			0.35	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	7		N	Brand	3	10	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	7		N	Specialty Tier	3	11	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Generic, Brand, Specialty Tier												
H2241	007	1	1	01	01	H2241_007_1	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	1	1	01	01	H2241_007_1	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2241	007	1	1	01	01	H2241_007_1	6		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	1	1	01	01	H2241_007_1	6		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2241	007	1	1	01	01	H2241_007_1	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	1	1	01	01	H2241_007_1	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	1	1	01	01	H2241_007_1	6		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	2	1	01	01	H2241_007_2	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	2	1	01	01	H2241_007_2	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2241	007	2	1	01	01	H2241_007_2	7		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	2	1	01	01	H2241_007_2	7		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2241	007	2	1	01	01	H2241_007_2	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	2	1	01	01	H2241_007_2	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	007	2	1	01	01	H2241_007_2	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	012	0	1	01	01	H2241_012_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	012	0	1	01	01	H2241_012_0	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2241	012	0	1	01	01	H2241_012_0	6		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	012	0	1	01	01	H2241_012_0	6		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2241	012	0	1	01	01	H2241_012_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	012	0	1	01	01	H2241_012_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	012	0	1	01	01	H2241_012_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	013	0	1	01	01	H2241_013_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	013	0	1	01	01	H2241_013_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2241	013	0	1	01	01	H2241_013_0	5		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	013	0	1	01	01	H2241_013_0	5		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2241	013	0	1	01	01	H2241_013_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	013	0	1	01	01	H2241_013_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	013	0	1	01	01	H2241_013_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	014	0	1	01	01	H2241_014_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	014	0	1	01	01	H2241_014_0	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2241	014	0	1	01	01	H2241_014_0	6		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	014	0	1	01	01	H2241_014_0	6		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2241	014	0	1	01	01	H2241_014_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	014	0	1	01	01	H2241_014_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	014	0	1	01	01	H2241_014_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	015	0	1	01	01	H2241_015_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	015	0	1	01	01	H2241_015_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2241	015	0	1	01	01	H2241_015_0	5		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	015	0	1	01	01	H2241_015_0	5		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2241	015	0	1	01	01	H2241_015_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	015	0	1	01	01	H2241_015_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	015	0	1	01	01	H2241_015_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	016	0	1	01	01	H2241_016_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	016	0	1	01	01	H2241_016_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2241	016	0	1	01	01	H2241_016_0	5		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	016	0	1	01	01	H2241_016_0	5		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2241	016	0	1	01	01	H2241_016_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	016	0	1	01	01	H2241_016_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	016	0	1	01	01	H2241_016_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	017	0	1	01	01	H2241_017_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	017	0	1	01	01	H2241_017_0	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2241	017	0	1	01	01	H2241_017_0	5		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	017	0	1	01	01	H2241_017_0	5		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2241	017	0	1	01	01	H2241_017_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	017	0	1	01	01	H2241_017_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	017	0	1	01	01	H2241_017_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2241	018	0	1	01	01	H2241_018_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	018	0	1	01	01	H2241_018_0	9		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2241	018	0	1	01	01	H2241_018_0	9		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	018	0	1	01	01	H2241_018_0	9		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2241	018	0	1	01	01	H2241_018_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	018	0	1	01	01	H2241_018_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	018	0	1	01	01	H2241_018_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	018	0	1	01	01	H2241_018_0	9		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	018	0	1	01	01	H2241_018_0	9		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2241	019	0	1	01	01	H2241_019_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	019	0	1	01	01	H2241_019_0	9		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2241	019	0	1	01	01	H2241_019_0	9		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	019	0	1	01	01	H2241_019_0	9		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2241	019	0	1	01	01	H2241_019_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	019	0	1	01	01	H2241_019_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	019	0	1	01	01	H2241_019_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	019	0	1	01	01	H2241_019_0	9		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	019	0	1	01	01	H2241_019_0	9		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2241	020	0	1	01	01	H2241_020_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	020	0	1	01	01	H2241_020_0	9		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2241	020	0	1	01	01	H2241_020_0	9		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	020	0	1	01	01	H2241_020_0	9		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2241	020	0	1	01	01	H2241_020_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	020	0	1	01	01	H2241_020_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	020	0	1	01	01	H2241_020_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	020	0	1	01	01	H2241_020_0	9		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	020	0	1	01	01	H2241_020_0	9		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2241	021	0	1	01	01	H2241_021_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	021	0	1	01	01	H2241_021_0	8		Y	Preferred Generic	4	01	1	2	1	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2241	021	0	1	01	01	H2241_021_0	8		Y	Generic	4	01	3	2	2	1	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	021	0	1	01	01	H2241_021_0	8		Y	Generic	4	01	3	2	2	3	111		01	100		1	31	60	90				2	2			90				31		31	10.00	20.00	30.00																					0.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2241	021	0	1	01	01	H2241_021_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	31	60	90				2	2			90				31		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	021	0	1	01	01	H2241_021_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	31	60	90				2	2			90				31		31	95.00	190.00	285.00																					190.00																95.00				95.00		3.06						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	021	0	1	01	01	H2241_021_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31				120.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	021	0	1	01	01	H2241_021_0	8		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2241	021	0	1	01	01	H2241_021_0	8		Y	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	31	60	90				2	2			90				31		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2256	001	1	1	01	01	H2256_001_1	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	1	1	01	01	H2256_001_1	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2256	001	1	1	01	01	H2256_001_1	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	1	1	01	01	H2256_001_1	11		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2256	001	1	1	01	01	H2256_001_1	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	1	1	01	01	H2256_001_1	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	1	1	01	01	H2256_001_1	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	1	1	01	01	H2256_001_1	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2256	001	2	1	01	01	H2256_001_2	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	11		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2256	001	2	1	01	01	H2256_001_2	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	2	1	01	01	H2256_001_2	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2256	001	6	1	01	01	H2256_001_6	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	11		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines										1		
H2256	001	6	1	01	01	H2256_001_6	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	001	6	1	01	01	H2256_001_6	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	1	1	01	01	H2256_015_1	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	2	1	01	01	H2256_015_2	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	015	6	1	01	01	H2256_015_6	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	1	1	01	01	H2256_018_1	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	12		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	12		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	12		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	12		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	7	1	01	01	H2256_018_7	12		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	018	8	1	01	01	H2256_018_8	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	1	1	01	01	H2256_026_1	11		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					0.00	0.00	0.00					0.00	0.00	0.00																14.00				0.00			0.47	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	1	1	01	01	H2256_026_1	11		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					4.00	8.00	12.00					4.00	8.00	8.00																19.00				4.00			0.63	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	1	1	01	01	H2256_026_1	11		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	1	1	01	01	H2256_026_1	11		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	1	1	01	01	H2256_026_1	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	1	1	01	01	H2256_026_1	11		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	2	1	01	01	H2256_026_2	11		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					0.00	0.00	0.00					0.00	0.00	0.00																14.00				0.00			0.47	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	2	1	01	01	H2256_026_2	11		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					4.00	8.00	12.00					4.00	8.00	8.00																19.00				4.00			0.63	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	2	1	01	01	H2256_026_2	11		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	2	1	01	01	H2256_026_2	11		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	2	1	01	01	H2256_026_2	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	2	1	01	01	H2256_026_2	11		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	11		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					0.00	0.00	0.00					0.00	0.00	0.00																14.00				0.00			0.47	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	11		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					4.00	8.00	12.00					4.00	8.00	8.00																19.00				4.00			0.63	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	11		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	11		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	026	3	1	01	01	H2256_026_3	11		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	028	0	1	01	01	H2256_028_0	11		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					0.00	0.00	0.00					0.00	0.00	0.00																14.00				0.00			0.47	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	028	0	1	01	01	H2256_028_0	11		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					4.00	8.00	12.00					4.00	8.00	8.00																19.00				4.00			0.63	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	028	0	1	01	01	H2256_028_0	11		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	028	0	1	01	01	H2256_028_0	11		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	028	0	1	01	01	H2256_028_0	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	028	0	1	01	01	H2256_028_0	11		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	033	0	1	01	01	H2256_033_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	033	0	1	01	01	H2256_033_0	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	033	0	1	01	01	H2256_033_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	033	0	1	01	01	H2256_033_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	033	0	1	01	01	H2256_033_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	033	0	1	01	01	H2256_033_0	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	034	0	1	01	01	H2256_034_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	034	0	1	01	01	H2256_034_0	11		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	034	0	1	01	01	H2256_034_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	034	0	1	01	01	H2256_034_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	034	0	1	01	01	H2256_034_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	034	0	1	01	01	H2256_034_0	11		N	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	036	0	1	01	01	H2256_036_0	11		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					0.00	0.00	0.00					0.00	0.00	0.00																14.00				0.00			0.47	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	036	0	1	01	01	H2256_036_0	11		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					4.00	8.00	12.00					4.00	8.00	8.00																19.00				4.00			0.63	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	036	0	1	01	01	H2256_036_0	11		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	036	0	1	01	01	H2256_036_0	11		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	036	0	1	01	01	H2256_036_0	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2256	036	0	1	01	01	H2256_036_0	11		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H2261	005	0	1	01	01	H2261_005_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	7		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	7		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	022	1	1	01	01	H2261_022_1	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					2.00	4.00	6.00					2.00	2.00	2.00																8.00				8.00			0.27	0.07	0.07			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	1	1	01	01	H2261_022_1	7		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					6.00	12.00	18.00					6.00	12.00	12.00																12.00				12.00			0.40	0.20	0.20			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	1	1	01	01	H2261_022_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	1	1	01	01	H2261_022_1	7		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	1	1	01	01	H2261_022_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	1	1	01	01	H2261_022_1	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	5.00	5.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	2	1	01	01	H2261_022_2	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					2.00	4.00	6.00					2.00	2.00	2.00																8.00				8.00			0.27	0.07	0.07			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	2	1	01	01	H2261_022_2	7		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					6.00	12.00	18.00					6.00	12.00	12.00																12.00				12.00			0.40	0.20	0.20			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	2	1	01	01	H2261_022_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	2	1	01	01	H2261_022_2	7		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	2	1	01	01	H2261_022_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	022	2	1	01	01	H2261_022_2	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	5.00	5.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	023	1	1	02	01	H2261_023_1	8		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	1	1	02	01	H2261_023_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	023	2	1	02	01	H2261_023_2	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	024	0	1	01	01	H2261_024_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					2.00	4.00	6.00					2.00	2.00	2.00																8.00				8.00			0.27	0.07	0.07			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	024	0	1	01	01	H2261_024_0	7		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00					8.00	16.00	16.00																16.00				16.00			0.53	0.27	0.27			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	024	0	1	01	01	H2261_024_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	024	0	1	01	01	H2261_024_0	7		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	024	0	1	01	01	H2261_024_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2261	024	0	1	01	01	H2261_024_0	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	5.00	5.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2288	001	0	1	01	01	H2288_001_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	001	0	1	01	01	H2288_001_0	6		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	001	0	1	01	01	H2288_001_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	001	0	1	01	01	H2288_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	001	0	1	01	01	H2288_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				651.04	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	001	0	1	01	01	H2288_001_0	6		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	001	0	1	01	01	H2288_001_0	6		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2288	002	0	1	01	01	H2288_002_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	002	0	1	01	01	H2288_002_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	002	0	1	01	01	H2288_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	002	0	1	01	01	H2288_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	002	0	1	01	01	H2288_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				593.91	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	002	0	1	01	01	H2288_002_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	002	0	1	01	01	H2288_002_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2288	005	0	1	01	01	H2288_005_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	005	0	1	01	01	H2288_005_0	5		N	Generic	4	11	1	1	2	1	110		01	110		1	30		90				1	2	30		90				30		31				7.70	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	005	0	1	01	01	H2288_005_0	5		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	30		90				1	2	30		90				30		31				109.37	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	005	0	1	01	01	H2288_005_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				62.20	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	005	0	1	01	01	H2288_005_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				570.57	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	005	0	1	01	01	H2288_005_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	005	0	1	01	01	H2288_005_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2288	009	0	1	01	01	H2288_009_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	009	0	1	01	01	H2288_009_0	5		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.4			0.4			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	009	0	1	01	01	H2288_009_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	009	0	1	01	01	H2288_009_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	90.00		270.00																			90.00		270.00																90.00				90.00		3.00			3.00			2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	009	0	1	01	01	H2288_009_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				718.28	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	009	0	1	01	01	H2288_009_0	5		Y	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	009	0	1	01	01	H2288_009_0	5		Y	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2288	010	0	1	01	01	H2288_010_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.4			0.4			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	90.00		270.00																			90.00		270.00																90.00				90.00		3.00			3.00			2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				743.06	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5		Y	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2288	010	0	1	01	01	H2288_010_0	5		Y	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2292	003	0	1	04	01	H2292_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2292	003	0	1	04	01	H2292_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2292	003	0	1	04	01	H2292_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				295.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	0.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											53.96	50	50	50				50.54	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	1	1	02	01	H2320_022_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	0.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											53.96	50	50	50				50.54	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	2	1	02	01	H2320_022_2	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	0.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											53.96	50	50	50				50.54	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	3	1	02	01	H2320_022_3	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	0.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											53.96	50	50	50				50.54	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	4	1	02	01	H2320_022_4	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	0.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											53.96	50	50	50				50.54	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	022	5	1	02	01	H2320_022_5	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.21	45	45	45				31.50	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	1	1	02	01	H2320_028_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	9		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.21	45	45	45				31.50	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	2	1	02	01	H2320_028_2	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.21	45	45	45				31.50	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	3	1	02	01	H2320_028_3	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.21	45	45	45				31.50	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	4	1	02	01	H2320_028_4	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	9		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.21	45	45	45				31.50	45	45	45				45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	028	5	1	02	01	H2320_028_5	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	1	1	02	01	H2320_029_1	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	1	1	02	01	H2320_029_1	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	1	1	02	01	H2320_029_1	8		Y	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	1	1	02	01	H2320_029_1	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.53	50	50	50				50.83	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	1	1	02	01	H2320_029_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	2	1	02	01	H2320_029_2	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	2	1	02	01	H2320_029_2	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	2	1	02	01	H2320_029_2	8		Y	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	2	1	02	01	H2320_029_2	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.53	50	50	50				50.83	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	2	1	02	01	H2320_029_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	3	1	02	01	H2320_029_3	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	3	1	02	01	H2320_029_3	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	3	1	02	01	H2320_029_3	8		Y	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	3	1	02	01	H2320_029_3	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.53	50	50	50				50.83	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	3	1	02	01	H2320_029_3	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	4	1	02	01	H2320_029_4	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	4	1	02	01	H2320_029_4	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	4	1	02	01	H2320_029_4	8		Y	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	4	1	02	01	H2320_029_4	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.53	50	50	50				50.83	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	4	1	02	01	H2320_029_4	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	5	1	02	01	H2320_029_5	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	5	1	02	01	H2320_029_5	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	5	1	02	01	H2320_029_5	8		Y	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	5	1	02	01	H2320_029_5	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.53	50	50	50				50.83	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	029	5	1	02	01	H2320_029_5	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.73	50	50	50				63.22	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	004	0	1	04	01	H2322_004_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.37	50	50	50				68.36	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	008	0	1	04	01	H2322_008_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.03	50	50	50				51.63	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	011	0	1	04	01	H2322_011_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								7.00	14.00	17.50					0.00	0.00	0.00											7.00	14.00	17.50				0.00	0.00	0.00				7.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											65.40	50	50	50				65.70	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2322	012	0	1	04	01	H2322_012_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	003	0	1	04	01	H2334_003_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	2	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								17.00		42.50					12.00		30.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	8		Y	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	2	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	2	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	2	2	30		90				30		31												29		29					29		29				29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	2	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								17.00		42.50					12.00		30.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	8		Y	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	2	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	2	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2334	005	0	1	04	01	H2334_005_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	2	2	30		90				30		31												29		29					29		29				29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	015	0	1	01	01	H2354_015_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	015	0	1	01	01	H2354_015_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	015	0	1	01	01	H2354_015_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.83	50	50	50				52.36	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	015	0	1	01	01	H2354_015_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	015	0	1	01	01	H2354_015_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	018	0	1	01	01	H2354_018_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	018	0	1	01	01	H2354_018_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	018	0	1	01	01	H2354_018_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	018	0	1	01	01	H2354_018_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											41.79	50	50	50				38.46	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	018	0	1	01	01	H2354_018_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	018	0	1	01	01	H2354_018_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	021	0	1	02	01	H2354_021_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	021	0	1	02	01	H2354_021_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	021	0	1	02	01	H2354_021_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	021	0	1	02	01	H2354_021_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											45.13	50	50	50				53.24	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	021	0	1	02	01	H2354_021_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	021	0	1	02	01	H2354_021_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	022	0	1	02	01	H2354_022_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	022	0	1	02	01	H2354_022_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	022	0	1	02	01	H2354_022_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	022	0	1	02	01	H2354_022_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.56	50	50	50				59.45	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	022	0	1	02	01	H2354_022_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	022	0	1	02	01	H2354_022_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											76.91	50	50	50				71.67	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	024	0	1	01	01	H2354_024_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	026	0	1	01	01	H2354_026_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	026	0	1	01	01	H2354_026_0	5		Y	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2354	026	0	1	01	01	H2354_026_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	026	0	1	01	01	H2354_026_0	5		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2354	026	0	1	01	01	H2354_026_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	026	0	1	01	01	H2354_026_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.64	50	50	50				50.89	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	026	0	1	01	01	H2354_026_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	026	0	1	01	01	H2354_026_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	5		Y	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	5		Y	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								6.00	12.00	15.00					0.00	0.00	0.00											6.00	12.00	15.00				0.00	0.00	0.00				6.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2354	027	0	1	01	01	H2354_027_0	5		Y	Generic	4	11	3	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	5		Y	Generic	4	11	3	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	37.50					10.00	20.00	25.00											15.00	30.00	37.50				10.00	20.00	0.00				15.00				10.00			0.50	0.33		0.50	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2354	027	0	1	01	01	H2354_027_0	5		Y	Preferred Brand	4	10	3	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	117.50					42.00	84.00	105.00											47.00	94.00	117.50				42.00	84.00	105.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											50.97	50	50	50				51.07	48	48	48										50	50	50				48	48	48			50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2354	027	0	1	01	01	H2354_027_0	5		Y	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2392	002	0	1	01	01	H2392_002_0	4		N	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								14	31	0.00	0.00	0.00																																						0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2392	002	0	1	01	01	H2392_002_0	4		N	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								14	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2392	002	0	1	01	01	H2392_002_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10			1	30	60	90				1	2								14	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2392	002	0	1	01	01	H2392_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10			1	30	60	90				1	2								14	31	98.00	196.00	294.00																																						98.00			98.00		3.27						3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2392	002	0	1	01	01	H2392_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10			1	30															14	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	008	0	1	04	01	H2406_008_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	008	0	1	04	01	H2406_008_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				265.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	009	0	1	04	01	H2406_009_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	009	0	1	04	01	H2406_009_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				294.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	010	0	1	04	01	H2406_010_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	010	0	1	04	01	H2406_010_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				269.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	011	0	1	04	01	H2406_011_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	011	0	1	04	01	H2406_011_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				313.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	012	0	1	04	01	H2406_012_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	012	0	1	04	01	H2406_012_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				393.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	013	0	1	04	01	H2406_013_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	013	0	1	04	01	H2406_013_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				343.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	014	0	1	04	01	H2406_014_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	014	0	1	04	01	H2406_014_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				354.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	015	0	1	04	01	H2406_015_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	015	0	1	04	01	H2406_015_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				397.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	016	0	1	04	01	H2406_016_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	016	0	1	04	01	H2406_016_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				408.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	017	0	1	04	01	H2406_017_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	017	0	1	04	01	H2406_017_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				262.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	018	0	1	04	01	H2406_018_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	018	0	1	04	01	H2406_018_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				393.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2406	019	0	1	04	01	H2406_019_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2406	019	0	1	04	01	H2406_019_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				388.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					2.00		6.00							4.00																10.00				2.00			0.33	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					8.00		24.00							16.00																20.00				8.00			0.67	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					35.00		105.00							70.00																47.00				35.00			1.57	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											53.58	50		50				56.46	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					2.00		6.00							4.00																10.00				2.00			0.33	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					8.00		24.00							16.00																20.00				8.00			0.67	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					35.00		105.00							70.00																47.00				35.00			1.57	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											54.80	50		50				60.44	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3			Preferred Generic	3	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3			Generic	3	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3			Preferred Brand	3	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					38.00		114.00							76.00																47.00				38.00			1.57	1.27				1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3			Non-Preferred Drug	3	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											80.22	50		50				78.00	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	3			Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					33.00		99.00							66.00																47.00				33.00			1.57	1.10				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											79.64	50		50				92.53	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					33.00		99.00							66.00																47.00				33.00			1.57	1.10				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											86.49	50		50				83.15	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					2.00		6.00							4.00																10.00				2.00			0.33	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					30.00		90.00							60.00																47.00				30.00			1.57	1.00				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											83.17	50		50				88.63	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					1.00		3.00							2.00																10.00				1.00			0.33	0.03				0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					8.00		24.00							16.00																20.00				8.00			0.67	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					30.00		90.00							60.00																47.00				30.00			1.57	1.00				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											84.87	50		50				81.45	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	035	0	1	18	06	H2450_035_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					7.00		21.00							14.00																20.00				7.00			0.67	0.23				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					28.00		84.00							56.00																47.00				28.00			1.57	0.93				0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											77.92	50		50				82.33	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	037	0	1	18	06	H2450_037_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					2.00		6.00							4.00																10.00				2.00			0.33	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					40.00		120.00							80.00																47.00				40.00			1.57	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											75.62	50		50				88.83	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	039	0	1	18	06	H2450_039_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					40.00		120.00							80.00																47.00				40.00			1.57	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											73.62	50		50				90.40	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	041	0	1	18	06	H2450_041_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_0	3			Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_0	3			Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					15.00		45.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_0	3			Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_0	3			Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											86.21	50		50				83.35	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	049	0	1	18	06	H2450_049_0	3			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		36.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5		Y	Preferred Brand	4	11	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											140.00	25		25				95.00	17		17										25		25				17		17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											57.00	50		50				51.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	020	0	1	02	01	H2459_020_0	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1294.00	25		25				1294.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	4		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	4		Y	Preferred Generic	4	11	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2459	021	1	1	02	01	H2459_021_1	4		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17.00		51.00					7.00		21.00											17.00		51.00				7.00		14.00					17.00			17.00			0.57	0.23		0.57	0.23	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	4		Y	Generic	4	11	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								17.00		51.00					7.00		21.00											17.00		51.00				7.00		14.00					17.00			17.00			0.57	0.23		0.57	0.23	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2459	021	1	1	02	01	H2459_021_1	4		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45.00		135.00					35.00		105.00											45.00		135.00				35.00		70.00					45.00			45.00			1.50	1.17		1.50	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											70.00	50		50				63.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	1	1	02	01	H2459_021_1	4		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2189.00	29		29				2189.00	29		29										29		29				29		29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	4		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	4		Y	Preferred Generic	4	11	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2459	021	2	1	02	01	H2459_021_2	4		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17.00		51.00					7.00		21.00											17.00		51.00				7.00		14.00					17.00			17.00			0.57	0.23		0.57	0.23	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	4		Y	Generic	4	11	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								17.00		51.00					7.00		21.00											17.00		51.00				7.00		14.00					17.00			17.00			0.57	0.23		0.57	0.23	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2459	021	2	1	02	01	H2459_021_2	4		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45.00		135.00					35.00		105.00											45.00		135.00				35.00		70.00					45.00			45.00			1.50	1.17		1.50	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											70.00	50		50				63.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	2	1	02	01	H2459_021_2	4		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2189.00	29		29				2189.00	29		29										29		29				29		29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	5		Y	Preferred Generic	4	11	1	2	1	3		110	10		110	1				30		90	1	2				30		90		29	31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2459	021	3	1	02	01	H2459_021_3	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17.00		51.00					7.00		21.00											17.00		51.00				7.00		14.00					17.00			17.00			0.57	0.23		0.57	0.23	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	5		Y	Generic	4	11	1	2	2	3		110	10		110	1				30		90	1	2				30		90		29	31								17.00		51.00					7.00		21.00											17.00		51.00				7.00		14.00					17.00			17.00			0.57	0.23		0.57	0.23	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2459	021	3	1	02	01	H2459_021_3	5		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45.00		135.00					35.00		105.00											45.00		135.00				35.00		70.00					45.00			45.00			1.50	1.17		1.50	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											70.00	50		50				63.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	021	3	1	02	01	H2459_021_3	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											2189.00	29		29				2189.00	29		29										29		29				29		29				29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					2.00		6.00											12.00		36.00				2.00		4.00					12.00			12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	5		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											51.00	50		50				46.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	1	1	02	01	H2459_023_1	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1589.00	25		25				1589.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					2.00		6.00											12.00		36.00				2.00		4.00					12.00			12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	5		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											51.00	50		50				46.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	023	2	1	02	01	H2459_023_2	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1589.00	25		25				1589.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		36.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	4		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	4		Y	Preferred Brand	4	11	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											121.00	25		25				82.00	17		17										25		25				17		17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											58.00	50		50				53.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	024	0	1	02	01	H2459_024_0	4		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1102.00	25		25				1102.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					0.00		0.00											12.00		36.00				0.00		0.00					12.00			12.00			0.40	0.00		0.40	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	5		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											59.00	50		50				53.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	1	1	02	01	H2459_026_1	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1714.00	28		28				1714.00	28		28										28		28				28		28				28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					0.00		0.00											12.00		36.00				0.00		0.00					12.00			12.00			0.40	0.00		0.40	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											59.00	50		50				53.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	3	1	02	01	H2459_026_3	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1714.00	28		28				1714.00	28		28										28		28				28		28				28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	4	1	02	01	H2459_026_4	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					0.00		0.00											12.00		36.00				0.00		0.00					12.00			12.00			0.40	0.00		0.40	0.00	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	4	1	02	01	H2459_026_4	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	4	1	02	01	H2459_026_4	5		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	4	1	02	01	H2459_026_4	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											59.00	50		50				53.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	026	4	1	02	01	H2459_026_4	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1714.00	28		28				1714.00	28		28										28		28				28		28				28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	6		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		36.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	6		Y	Generic	4	11	1	1	2	1		110	10		110	1				30		90	1	2				30		90		29	31											7.00	25		25				6.00	20		20										25		25				20		20				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	6		Y	Preferred Brand	4	11	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											121.00	25		25				97.00	20		20										25		25				20		20				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											58.00	50		50				53.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	028	0	1	02	01	H2459_028_0	6		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1102.00	25		25				1102.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	029	0	1	02	01	H2459_029_0	9		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					2.00		6.00											12.00		36.00				2.00		4.00					12.00			12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	029	0	1	02	01	H2459_029_0	9		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	029	0	1	02	01	H2459_029_0	9		Y	Preferred Brand	4	11	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											137.00	25		25				93.00	17		17										25		25				17		17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	029	0	1	02	01	H2459_029_0	9		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											51.00	50		50				46.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	029	0	1	02	01	H2459_029_0	9		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1589.00	25		25				1589.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	10		Y	Preferred Generic	4	11	1	2	1	1	110		10	110		1	30		90				1	1	30		90					29	31	5.00		15.00																			5.00		15.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	10		Y	Generic	4	11	1	2	2	1	110		10	110		1	30		90				1	1	30		90					29	31	13.00		39.00																			13.00		39.00																	13.00			13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	10		Y	Preferred Brand	4	11	1	2	3	1	110		10	110		1	30		90				1	1	30		90					29	31	47.00		141.00																			47.00		141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	10		Y	Non-Preferred Drug	4	11	1	1	4	1	110		10	110		1	30		90				1	1	30		90					29	31				49.90	25		25																		25		25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	031	0	1	01	01	H2459_031_0	10		Y	Specialty Tier	4	11	1	1	5	1	110		10	110		1	30		90				1	1	30		90					29	31				819.94	25		25																		25		25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	032	0	1	01	01	H2459_032_0	10		Y	Preferred Generic	4	11	1	2	1	1	110		10	110		1	30		90				1	1	30		90					29	31	4.00		12.00																			4.00		12.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	032	0	1	01	01	H2459_032_0	10		Y	Generic	4	11	1	2	2	1	110		10	110		1	30		90				1	1	30		90					29	31	12.00		36.00																			12.00		36.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	032	0	1	01	01	H2459_032_0	10		Y	Preferred Brand	4	11	1	2	3	1	110		10	110		1	30		90				1	1	30		90					29	31	45.00		135.00																			45.00		135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	032	0	1	01	01	H2459_032_0	10		Y	Non-Preferred Drug	4	11	1	1	4	1	110		10	110		1	30		90				1	1	30		90					29	31				49.90	25		25																		25		25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	032	0	1	01	01	H2459_032_0	10		Y	Specialty Tier	4	11	1	1	5	1	110		10	110		1	30		90				1	1	30		90					29	31				819.94	25		25																		25		25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	3			Preferred Generic	2	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								15.00	30.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				15.00			0.48	0.00	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	3			Generic	2	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								20.00	40.00	40.00					12.00	24.00	24.00					12.00	24.00	24.00																20.00				20.00			0.65	0.39	0.39			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	3			Preferred Brand	2	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											45.94	25	25	25				44.72	21	21	21				21	21	21															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	3			Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											75.63	50	50	50				84.39	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	3			Specialty Tier	2	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	009	0	1	18	06	H2461_009_0	3			Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								15.00	30.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				15.00			0.48	0.00	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	009	0	1	18	06	H2461_009_0	3			Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								20.00	40.00	40.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.65	0.32	0.32			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	009	0	1	18	06	H2461_009_0	3			Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											56.77	25	25	25				50.47	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	009	0	1	18	06	H2461_009_0	3			Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											98.39	50	50	50				88.22	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	009	0	1	18	06	H2461_009_0	3			Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	010	0	1	18	06	H2461_010_0	3			Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								13.00	26.00	26.00					0.00	0.00	0.00					0.00	0.00	0.00																13.00				13.00			0.42	0.00	0.00			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	010	0	1	18	06	H2461_010_0	3			Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								19.00	38.00	38.00					9.00	18.00	18.00					9.00	18.00	18.00																19.00				19.00			0.61	0.29	0.29			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	010	0	1	18	06	H2461_010_0	3			Preferred Brand	4	11	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											62.66	25	25	25				47.75	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	010	0	1	18	06	H2461_010_0	3			Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											95.65	50	50	50				86.18	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	010	0	1	18	06	H2461_010_0	3			Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2463	001	0	1	01	01	H2463_001_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	6		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	6		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	005	0	1	01	01	H2486_005_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	006	0	1	01	01	H2486_006_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	007	0	1	01	01	H2486_007_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	008	0	1	01	01	H2486_008_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				99.60	43		43																								43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.17	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H2491	007	0	1	01	01	H2491_007_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.87	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.00	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	009	0	1	01	01	H2491_009_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	009	0	1	01	01	H2491_009_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	009	0	1	01	01	H2491_009_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	009	0	1	01	01	H2491_009_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	009	0	1	01	01	H2491_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	010	0	1	01	01	H2491_010_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	010	0	1	01	01	H2491_010_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	010	0	1	01	01	H2491_010_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	010	0	1	01	01	H2491_010_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.13	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	010	0	1	01	01	H2491_010_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	011	0	1	01	01	H2491_011_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	011	0	1	01	01	H2491_011_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	011	0	1	01	01	H2491_011_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	011	0	1	01	01	H2491_011_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.97	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	011	0	1	01	01	H2491_011_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	012	0	1	01	01	H2491_012_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	012	0	1	01	01	H2491_012_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	012	0	1	01	01	H2491_012_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	012	0	1	01	01	H2491_012_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.40	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	012	0	1	01	01	H2491_012_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	013	0	1	01	01	H2491_013_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	013	0	1	01	01	H2491_013_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	013	0	1	01	01	H2491_013_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	013	0	1	01	01	H2491_013_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.71	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	013	0	1	01	01	H2491_013_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	014	0	1	01	01	H2491_014_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	014	0	1	01	01	H2491_014_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H2491	014	0	1	01	01	H2491_014_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	014	0	1	01	01	H2491_014_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	014	0	1	01	01	H2491_014_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.47	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	014	0	1	01	01	H2491_014_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	015	0	1	01	01	H2491_015_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	015	0	1	01	01	H2491_015_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	015	0	1	01	01	H2491_015_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	015	0	1	01	01	H2491_015_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	015	0	1	01	01	H2491_015_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	016	0	1	01	01	H2491_016_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	016	0	1	01	01	H2491_016_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2491	016	0	1	01	01	H2491_016_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	016	0	1	01	01	H2491_016_0	5		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2491	016	0	1	01	01	H2491_016_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	016	0	1	01	01	H2491_016_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	016	0	1	01	01	H2491_016_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2506	001	0	1	48	05	H2506_001_0	3			Generic Drugs	4	11			1	1	111		10	111		1	30	60	90				2	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	3			Brand Drugs	4	11			2	1	111		10	111		1	30	60	90				2	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H2531	001	0	1	48	05	H2531_001_0	3			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.70	0.00	3.70	0.00	3.70	0.00	3.70			
H2531	001	0	1	48	05	H2531_001_0	3			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.20	0.00	9.20	0.00	9.20	0.00	9.20			
H2531	001	0	1	48	05	H2531_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	3			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	3			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2533	001	0	1	48	05	H2533_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2563	005	1	1	01	01	H2563_005_1	11		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	11		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					0.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	11		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	11		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	1	1	01	01	H2563_005_1	11		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				856.94	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					0.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	005	2	1	01	01	H2563_005_2	11		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				856.94	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	8		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	8		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	8		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	008	0	1	01	01	H2563_008_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				779.75	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	9		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	9		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	9		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	9		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	009	0	1	01	01	H2563_009_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				757.79	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	8		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	8		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					0.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	8		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	012	0	1	01	01	H2563_012_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				892.04	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	9		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	9		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					0.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	9		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	9		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	013	0	1	01	01	H2563_013_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				885.29	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	9		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	9		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	9		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	9		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	015	0	1	01	01	H2563_015_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				738.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	10		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	10		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	10		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	10		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	016	0	1	01	01	H2563_016_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				765.47	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	1	1	01	01	H2563_017_1	11		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				703.96	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11		N	Generic	4	01	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					0.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2563	017	2	1	01	01	H2563_017_2	11		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				703.96	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	001	1	1	04	01	H2577_001_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	1	1	04	01	H2577_001_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				244.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	001	2	1	04	01	H2577_001_2	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	001	2	1	04	01	H2577_001_2	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				244.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	002	0	1	04	01	H2577_002_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	002	0	1	04	01	H2577_002_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											271.00	29						313.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	003	1	1	04	01	H2577_003_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	1	1	04	01	H2577_003_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				218.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	003	2	1	04	01	H2577_003_2	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	003	2	1	04	01	H2577_003_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				218.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	004	0	1	04	01	H2577_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	004	0	1	04	01	H2577_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				334.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	005	0	1	04	01	H2577_005_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	005	0	1	04	01	H2577_005_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											183.00	31						225.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	006	0	1	04	01	H2577_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	006	0	1	04	01	H2577_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				236.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		10.00													45.00						10.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		10.00													45.00						10.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	007	0	1	04	01	H2577_007_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	007	0	1	04	01	H2577_007_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											372.00	33						249.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	4		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		10.00													45.00						10.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	4		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		10.00													45.00						10.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	008	0	1	04	01	H2577_008_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	008	0	1	04	01	H2577_008_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											392.00	33						245.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	009	0	1	04	01	H2577_009_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	009	0	1	04	01	H2577_009_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											344.00	29						319.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	011	0	1	04	01	H2577_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	011	0	1	04	01	H2577_011_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				381.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	6		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	6		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	6		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	013	0	1	04	01	H2577_013_0	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	013	0	1	04	01	H2577_013_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											297.00	29						322.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	014	0	1	04	01	H2577_014_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	014	0	1	04	01	H2577_014_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				325.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	016	0	1	04	01	H2577_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	016	0	1	04	01	H2577_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				346.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	017	0	1	04	01	H2577_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	017	0	1	04	01	H2577_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				276.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	018	0	1	04	01	H2577_018_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	018	0	1	04	01	H2577_018_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				347.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	020	0	1	04	01	H2577_020_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	020	0	1	04	01	H2577_020_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				339.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2577	021	0	1	04	01	H2577_021_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2577	021	0	1	04	01	H2577_021_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				445.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	01	01	H2582_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	01	01	H2582_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	01	01	H2582_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2582	004	0	1	01	01	H2582_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	01	01	H2582_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	004	0	1	01	01	H2582_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	01	01	H2582_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	01	01	H2582_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	01	01	H2582_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2582	005	0	1	01	01	H2582_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	01	01	H2582_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2582	005	0	1	01	01	H2582_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				342.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2593	001	0	1	01	01	H2593_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	003	0	1	01	01	H2593_003_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	003	0	1	01	01	H2593_003_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	003	0	1	01	01	H2593_003_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	005	0	1	01	01	H2593_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	006	0	1	01	01	H2593_006_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	013	0	1	01	01	H2593_013_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	018	0	1	01	01	H2593_018_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.50	31.00	46.50					10.50	21.00	31.50					10.50	21.00	21.00																15.50				15.50			0.52	0.35	0.35			.46	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	019	0	1	01	01	H2593_019_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	019	0	1	01	01	H2593_019_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	021	0	1	01	01	H2593_021_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	021	0	1	01	01	H2593_021_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	021	0	1	01	01	H2593_021_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	021	0	1	01	01	H2593_021_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	022	0	1	01	01	H2593_022_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	16.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	022	0	1	01	01	H2593_022_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	023	0	1	01	01	H2593_023_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	16.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	023	0	1	01	01	H2593_023_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	024	0	1	01	01	H2593_024_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	024	0	1	01	01	H2593_024_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	024	0	1	01	01	H2593_024_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	024	0	1	01	01	H2593_024_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	024	0	1	01	01	H2593_024_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	024	0	1	01	01	H2593_024_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	024	0	1	01	01	H2593_024_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	025	0	1	01	01	H2593_025_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	025	0	1	01	01	H2593_025_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00	27.00	27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	270.00	270.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	025	0	1	01	01	H2593_025_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	026	0	1	01	01	H2593_026_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	026	0	1	01	01	H2593_026_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	026	0	1	01	01	H2593_026_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	026	0	1	01	01	H2593_026_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	026	0	1	01	01	H2593_026_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	026	0	1	01	01	H2593_026_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	026	0	1	01	01	H2593_026_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	027	0	1	01	01	H2593_027_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	027	0	1	01	01	H2593_027_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	027	0	1	01	01	H2593_027_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	027	0	1	01	01	H2593_027_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	027	0	1	01	01	H2593_027_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	027	0	1	01	01	H2593_027_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	027	0	1	01	01	H2593_027_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	1	1	01	01	H2593_028_1	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	1	1	01	01	H2593_028_1	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	1	1	01	01	H2593_028_1	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	1	1	01	01	H2593_028_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	1	1	01	01	H2593_028_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	1	1	01	01	H2593_028_1	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	1	1	01	01	H2593_028_1	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	2	1	01	01	H2593_028_2	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	2	1	01	01	H2593_028_2	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	2	1	01	01	H2593_028_2	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	2	1	01	01	H2593_028_2	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	2	1	01	01	H2593_028_2	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	2	1	01	01	H2593_028_2	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	2	1	01	01	H2593_028_2	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	3	1	01	01	H2593_028_3	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	3	1	01	01	H2593_028_3	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	3	1	01	01	H2593_028_3	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	3	1	01	01	H2593_028_3	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	3	1	01	01	H2593_028_3	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	3	1	01	01	H2593_028_3	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	3	1	01	01	H2593_028_3	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	4	1	01	01	H2593_028_4	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	4	1	01	01	H2593_028_4	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	4	1	01	01	H2593_028_4	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	4	1	01	01	H2593_028_4	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	4	1	01	01	H2593_028_4	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	4	1	01	01	H2593_028_4	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	4	1	01	01	H2593_028_4	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	5	1	01	01	H2593_028_5	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	5	1	01	01	H2593_028_5	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	5	1	01	01	H2593_028_5	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	5	1	01	01	H2593_028_5	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	5	1	01	01	H2593_028_5	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	5	1	01	01	H2593_028_5	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	5	1	01	01	H2593_028_5	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	028	6	1	01	01	H2593_028_6	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	6	1	01	01	H2593_028_6	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	6	1	01	01	H2593_028_6	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	6	1	01	01	H2593_028_6	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	6	1	01	01	H2593_028_6	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	6	1	01	01	H2593_028_6	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	028	6	1	01	01	H2593_028_6	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	029	0	1	01	01	H2593_029_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	029	0	1	01	01	H2593_029_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	1	1	01	01	H2593_030_1	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	1	1	01	01	H2593_030_1	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	1	1	01	01	H2593_030_1	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	1	1	01	01	H2593_030_1	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	1	1	01	01	H2593_030_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	1	1	01	01	H2593_030_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	1	1	01	01	H2593_030_1	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	1	1	01	01	H2593_030_1	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	2	1	01	01	H2593_030_2	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	2	1	01	01	H2593_030_2	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	2	1	01	01	H2593_030_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	2	1	01	01	H2593_030_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	2	1	01	01	H2593_030_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	2	1	01	01	H2593_030_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	2	1	01	01	H2593_030_2	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	2	1	01	01	H2593_030_2	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	3	1	01	01	H2593_030_3	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	3	1	01	01	H2593_030_3	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	3	1	01	01	H2593_030_3	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	3	1	01	01	H2593_030_3	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	3	1	01	01	H2593_030_3	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	3	1	01	01	H2593_030_3	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	3	1	01	01	H2593_030_3	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	3	1	01	01	H2593_030_3	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	4	1	01	01	H2593_030_4	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	4	1	01	01	H2593_030_4	7		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	4	1	01	01	H2593_030_4	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	4	1	01	01	H2593_030_4	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	4	1	01	01	H2593_030_4	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	4	1	01	01	H2593_030_4	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	4	1	01	01	H2593_030_4	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	4	1	01	01	H2593_030_4	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	5	1	01	01	H2593_030_5	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	5	1	01	01	H2593_030_5	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	5	1	01	01	H2593_030_5	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	5	1	01	01	H2593_030_5	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	5	1	01	01	H2593_030_5	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	5	1	01	01	H2593_030_5	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	5	1	01	01	H2593_030_5	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	5	1	01	01	H2593_030_5	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	030	6	1	01	01	H2593_030_6	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	6	1	01	01	H2593_030_6	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	030	6	1	01	01	H2593_030_6	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	6	1	01	01	H2593_030_6	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	6	1	01	01	H2593_030_6	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	6	1	01	01	H2593_030_6	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	6	1	01	01	H2593_030_6	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	030	6	1	01	01	H2593_030_6	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	031	0	1	02	01	H2593_031_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00	279.00	279.00																98.00				98.00			3.27	3.10	3.10			2.88	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	031	0	1	02	01	H2593_031_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	032	0	1	01	01	H2593_032_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2593	032	0	1	01	01	H2593_032_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	032	0	1	01	01	H2593_032_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	033	0	1	01	01	H2593_033_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	033	0	1	01	01	H2593_033_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	033	0	1	01	01	H2593_033_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	033	0	1	01	01	H2593_033_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	033	0	1	01	01	H2593_033_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	033	0	1	01	01	H2593_033_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	033	0	1	01	01	H2593_033_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	033	0	1	01	01	H2593_033_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	034	0	1	01	01	H2593_034_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	034	0	1	01	01	H2593_034_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	034	0	1	01	01	H2593_034_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	034	0	1	01	01	H2593_034_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	034	0	1	01	01	H2593_034_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	034	0	1	01	01	H2593_034_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	034	0	1	01	01	H2593_034_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	034	0	1	01	01	H2593_034_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	035	0	1	01	01	H2593_035_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	035	0	1	01	01	H2593_035_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	035	0	1	01	01	H2593_035_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00	36.00	36.00																12.00				12.00			0.40	0.40	0.40			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	035	0	1	01	01	H2593_035_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	035	0	1	01	01	H2593_035_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	035	0	1	01	01	H2593_035_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	035	0	1	01	01	H2593_035_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	035	0	1	01	01	H2593_035_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	036	0	1	01	01	H2593_036_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	036	0	1	01	01	H2593_036_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	036	0	1	01	01	H2593_036_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	036	0	1	01	01	H2593_036_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	036	0	1	01	01	H2593_036_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	036	0	1	01	01	H2593_036_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	036	0	1	01	01	H2593_036_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	036	0	1	01	01	H2593_036_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	037	0	1	01	01	H2593_037_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	037	0	1	01	01	H2593_037_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	037	0	1	01	01	H2593_037_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	037	0	1	01	01	H2593_037_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	038	0	1	01	01	H2593_038_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	038	0	1	01	01	H2593_038_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	038	0	1	01	01	H2593_038_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	038	0	1	01	01	H2593_038_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	039	0	1	01	01	H2593_039_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	039	0	1	01	01	H2593_039_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	039	0	1	01	01	H2593_039_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	039	0	1	01	01	H2593_039_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	040	0	1	01	01	H2593_040_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	040	0	1	01	01	H2593_040_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	040	0	1	01	01	H2593_040_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	040	0	1	01	01	H2593_040_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	041	0	1	01	01	H2593_041_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	041	0	1	01	01	H2593_041_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	041	0	1	01	01	H2593_041_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	041	0	1	01	01	H2593_041_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	042	0	1	01	01	H2593_042_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	042	0	1	01	01	H2593_042_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	4		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	042	0	1	01	01	H2593_042_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	042	0	1	01	01	H2593_042_0	4		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2610	005	0	1	01	01	H2610_005_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							0.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	005	0	1	01	01	H2610_005_0	7		N	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	005	0	1	01	01	H2610_005_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					39.00	78.00	117.00							97.50																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	005	0	1	01	01	H2610_005_0	7		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					75.00	150.00	225.00							187.50																100.00				100.00			3.33	2.50				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	005	0	1	01	01	H2610_005_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											789.72	33						789.72	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	005	0	1	01	01	H2610_005_0	7		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01	100		1				30	60	90	1	2			90				30		31								0.00	0.00	0.00					0.00	0.00	0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	006	0	1	01	01	H2610_006_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							0.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	006	0	1	01	01	H2610_006_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							0.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2610	006	0	1	01	01	H2610_006_0	7		N	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	006	0	1	01	01	H2610_006_0	7		N	Generic	4	01	3	2	2	3		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		3
H2610	006	0	1	01	01	H2610_006_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								42.00	84.00	126.00					34.00	68.00	102.00							85.00																42.00				42.00			1.40	1.13				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	006	0	1	01	01	H2610_006_0	7		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								80.00	160.00	240.00					65.00	130.00	195.00							162.50																80.00				80.00			2.67	2.17				2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	006	0	1	01	01	H2610_006_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											645.92	33						645.92	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	006	0	1	01	01	H2610_006_0	7		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01	100		1				30	60	90	1	2			90				30		31								0.00	0.00	0.00					0.00	0.00	0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	006	0	1	01	01	H2610_006_0	7		N	Select Diabetic Drugs	4	11	1	2	6	3		111	01	100		1				30	60	90	1	2			90				30		31								0.00	0.00	0.00					0.00	0.00	0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H2610	011	0	1	01	01	H2610_011_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	011	0	1	01	01	H2610_011_0	7		N	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	011	0	1	01	01	H2610_011_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					42.00	84.00	126.00							105.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	011	0	1	01	01	H2610_011_0	7		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								95.00	190.00	285.00					85.00	170.00	255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	011	0	1	01	01	H2610_011_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											750.77	33						750.77	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	011	0	1	01	01	H2610_011_0	7		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01	100		1				30	60	90	1	2			90				30		31								0.00	0.00	0.00					0.00	0.00	0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	7		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					0.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	7		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	7		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				581.11	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	015	0	1	01	01	H2610_015_0	7		N	Select Diabetic Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	016	0	1	01	01	H2610_016_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							0.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	016	0	1	01	01	H2610_016_0	7		N	Generic	4	01	3	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	016	0	1	01	01	H2610_016_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					39.00	78.00	117.00							97.50																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	016	0	1	01	01	H2610_016_0	7		N	Non-Preferred Brand	4	10	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					75.00	150.00	225.00							187.50																100.00				100.00			3.33	2.50				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	016	0	1	01	01	H2610_016_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											709.08	33						709.08	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2610	016	0	1	01	01	H2610_016_0	7		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01	100		1				30	60	90	1	2			90				30		31								0.00	0.00	0.00					0.00	0.00	0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2624	001	0	1	01	01	H2624_001_0	8		Y	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90.00	180.00	180.00																			90.00	180.00	180.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1109.21	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Select Care Drugs	4	11	1	2	6	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2624	001	0	1	01	01	H2624_001_0	8		Y	Select Care Drugs	4	11	1	2	6	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2663	002	0	1	01	01	H2663_002_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H2663	002	0	1	01	01	H2663_002_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2663	002	0	1	01	01	H2663_002_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H2663	002	0	1	01	01	H2663_002_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2663	002	0	1	01	01	H2663_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	002	0	1	01	01	H2663_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	002	0	1	01	01	H2663_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											792.94	33						611.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	005	0	1	01	01	H2663_005_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	005	0	1	01	01	H2663_005_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	005	0	1	01	01	H2663_005_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	005	0	1	01	01	H2663_005_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	005	0	1	01	01	H2663_005_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	005	0	1	01	01	H2663_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	005	0	1	01	01	H2663_005_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											717.25	33						542.58	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	006	0	1	02	01	H2663_006_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	006	0	1	02	01	H2663_006_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	006	0	1	02	01	H2663_006_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	006	0	1	02	01	H2663_006_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	006	0	1	02	01	H2663_006_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	006	0	1	02	01	H2663_006_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	006	0	1	02	01	H2663_006_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											880.18	33						681.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	015	0	1	02	01	H2663_015_0	5		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H2663	015	0	1	02	01	H2663_015_0	5		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2663	015	0	1	02	01	H2663_015_0	5		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H2663	015	0	1	02	01	H2663_015_0	5		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2663	015	0	1	02	01	H2663_015_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	015	0	1	02	01	H2663_015_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	015	0	1	02	01	H2663_015_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											614.79	33						479.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	017	0	1	01	01	H2663_017_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	017	0	1	01	01	H2663_017_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	017	0	1	01	01	H2663_017_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	017	0	1	01	01	H2663_017_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	017	0	1	01	01	H2663_017_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	017	0	1	01	01	H2663_017_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	017	0	1	01	01	H2663_017_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											779.20	33						518.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	021	0	1	01	01	H2663_021_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	021	0	1	01	01	H2663_021_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	021	0	1	01	01	H2663_021_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	021	0	1	01	01	H2663_021_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	021	0	1	01	01	H2663_021_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	021	0	1	01	01	H2663_021_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	021	0	1	01	01	H2663_021_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											652.47	33						689.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	023	0	1	02	01	H2663_023_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	023	0	1	02	01	H2663_023_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	023	0	1	02	01	H2663_023_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	023	0	1	02	01	H2663_023_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	023	0	1	02	01	H2663_023_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	023	0	1	02	01	H2663_023_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	023	0	1	02	01	H2663_023_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											621.21	33						577.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	026	0	1	01	01	H2663_026_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	026	0	1	01	01	H2663_026_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	026	0	1	01	01	H2663_026_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	026	0	1	01	01	H2663_026_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	026	0	1	01	01	H2663_026_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	026	0	1	01	01	H2663_026_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	026	0	1	01	01	H2663_026_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											794.01	33						448.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	028	0	1	01	01	H2663_028_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	028	0	1	01	01	H2663_028_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	028	0	1	01	01	H2663_028_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	028	0	1	01	01	H2663_028_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	028	0	1	01	01	H2663_028_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	028	0	1	01	01	H2663_028_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	028	0	1	01	01	H2663_028_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											597.06	33						377.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	029	0	1	01	01	H2663_029_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	029	0	1	01	01	H2663_029_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	029	0	1	01	01	H2663_029_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	029	0	1	01	01	H2663_029_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	029	0	1	01	01	H2663_029_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	029	0	1	01	01	H2663_029_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	029	0	1	01	01	H2663_029_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											781.32	33						585.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	032	0	1	01	01	H2663_032_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	032	0	1	01	01	H2663_032_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	032	0	1	01	01	H2663_032_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	032	0	1	01	01	H2663_032_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	032	0	1	01	01	H2663_032_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	032	0	1	01	01	H2663_032_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	032	0	1	01	01	H2663_032_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											787.31	33						568.62	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	034	0	1	01	01	H2663_034_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	034	0	1	01	01	H2663_034_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	034	0	1	01	01	H2663_034_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	034	0	1	01	01	H2663_034_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	034	0	1	01	01	H2663_034_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	034	0	1	01	01	H2663_034_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	034	0	1	01	01	H2663_034_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											628.28	29						468.12	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	035	0	1	01	01	H2663_035_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	035	0	1	01	01	H2663_035_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	035	0	1	01	01	H2663_035_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	035	0	1	01	01	H2663_035_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	035	0	1	01	01	H2663_035_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	035	0	1	01	01	H2663_035_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	035	0	1	01	01	H2663_035_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											725.48	33						534.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	036	0	1	01	01	H2663_036_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	036	0	1	01	01	H2663_036_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	036	0	1	01	01	H2663_036_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	036	0	1	01	01	H2663_036_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	036	0	1	01	01	H2663_036_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	036	0	1	01	01	H2663_036_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2663	036	0	1	01	01	H2663_036_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											770.95	33						566.98	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2678	001	0	1	01	01	H2678_001_0	4		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		100				2	2			100				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2678	001	0	1	01	01	H2678_001_0	4		N	Generic	4	01	1	2	2	1	110		01	100		1	30		100				2	2			100				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2678	001	0	1	01	01	H2678_001_0	4		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		100				2	2			100				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2678	001	0	1	01	01	H2678_001_0	4		N	Non-Preferred Brand	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				91.10	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2678	001	0	1	01	01	H2678_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2678	001	0	1	01	01	H2678_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2678	002	0	1	01	01	H2678_002_0	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	002	0	1	01	01	H2678_002_0	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		100				2	2			100				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	002	0	1	01	01	H2678_002_0	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		100				2	2			100				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	002	0	1	01	01	H2678_002_0	3		N	Non-Preferred Brand	4	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				97.09	43		43																				43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	002	0	1	01	01	H2678_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	3		N	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	3		N	Generic	3	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	18.00		54.00																					54.00																18.00				18.00		0.60						0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	3		N	Preferred Brand	3	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	3		N	Non-Preferred Brand	3	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				56.57	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	003	0	1	01	01	H2678_003_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	3		N	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	3		N	Generic	3	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	18.00		54.00																					54.00																18.00				18.00		0.60						0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	3		N	Preferred Brand	3	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		135.00																					135.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	3		N	Non-Preferred Brand	3	10	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				61.35	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2678	004	0	1	01	01	H2678_004_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2697	001	0	1	01	01	H2697_001_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2697	001	0	1	01	01	H2697_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	42.00	84.00	126.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	001	0	1	01	01	H2697_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1101.05	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2697	002	0	1	01	01	H2697_002_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	8		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2697	002	0	1	01	01	H2697_002_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	42.00	84.00	126.00																			42.00	84.00	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	002	0	1	01	01	H2697_002_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				835.60	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	003	0	1	01	01	H2697_003_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	003	0	1	01	01	H2697_003_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	003	0	1	01	01	H2697_003_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	003	0	1	01	01	H2697_003_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2697	003	0	1	01	01	H2697_003_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				672.99	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2722	001	0	1	02	01	H2722_001_0	7		N	Preferred Generic	2	01	1	2	1	1	110		01		110	1	31		100				1	2				31		100	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	001	0	1	02	01	H2722_001_0	7		N	Generic	2	01	1	2	2	1	110		01		100	1	31		100				1	2						100	31		31	8.00		24.00																											24.00						24.00				8.00				8.00		0.26						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	001	0	1	02	01	H2722_001_0	7		N	Preferred Brand	2	10	1	1	3	1	110		01		100	1	31		100				1	2						100	31		31				118.32	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	001	0	1	02	01	H2722_001_0	7		N	Non-Preferred Brand	2	10	1	1	4	1	110		01		100	1	31		100				1	2						100	31		31				119.15	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	001	0	1	02	01	H2722_001_0	7		N	Specialty Tier	2	10	1	1	5	1	010		01		010	1	31											31			31		31				1094.68	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		100				1	2				31		100	31		31	7.00		21.00																									7.00		21.00				0.00		0.00				7.00				7.00		0.23				0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	6		Y	Generic	4	01	1	2	2	1	110		01		100	1	31		100				1	2						100	31		31	15.00		45.00																											45.00						45.00				15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	6		Y	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		100				1	2						100	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	6		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01		100	1	31		100				1	2						100	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	002	0	1	02	01	H2722_002_0	6		Y	Specialty Tier	4	10	1	1	5	1	010		01		010	1	31											31			31		31				1385.47	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	003	0	1	02	01	H2722_003_0	6		N	Preferred Generic	2	01	1	2	1	1	110		01		110	1	31		100				1	2				31		100	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	003	0	1	02	01	H2722_003_0	6		N	Generic	2	01	1	2	2	1	110		01		100	1	31		100				1	2						100	31		31	8.00		24.00																											24.00						24.00				8.00				8.00		0.26						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	003	0	1	02	01	H2722_003_0	6		N	Preferred Brand	2	10	1	1	3	1	110		01		100	1	31		100				1	2						100	31		31				118.32	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	003	0	1	02	01	H2722_003_0	6		N	Non-Preferred Brand	2	10	1	1	4	1	110		01		100	1	31		100				1	2						100	31		31				119.15	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	003	0	1	02	01	H2722_003_0	6		N	Specialty Tier	2	10	1	1	5	1	010		01		010	1	31											31			31		31				1094.68	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		100				1	2				31		100	31		31	5.00		15.00																									5.00		15.00				0.00		0.00				5.00				5.00		0.16				0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	7		Y	Generic	4	01	1	2	2	1	110		01		100	1	31		100				1	2						100	31		31	14.00		42.00																											42.00						42.00				14.00				14.00		0.45						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	7		Y	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		100				1	2						100	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	7		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01		100	1	31		100				1	2						100	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2722	004	0	1	02	01	H2722_004_0	7		Y	Specialty Tier	4	10	1	1	5	1	010		01		010	1	31											31			31		31				1342.74	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2765	002	0	1	01	01	H2765_002_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				500.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	002	0	1	01	01	H2765_002_0	7		N	Vaccines	4	10	1	2	6	1	010		01	010		1	30								30						30		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	8		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	8		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				500.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	003	0	1	02	01	H2765_003_0	8		N	Vaccines	4	10	1	2	6	1	010		01	010		1	30								30						30		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	8		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	8		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				500.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2765	004	0	1	02	01	H2765_004_0	8		N	Vaccines	4	10	1	2	6	1	010		01	010		1	30								30						30		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2775	100	0	1	04	01	H2775_100_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	105	0	1	04	01	H2775_105_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	105	0	1	04	01	H2775_105_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	105	0	1	04	01	H2775_105_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					35.00		105.00											45.00		135.00				35.00		70.00				45.00				45.00			1.5	1.17		1.5	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	105	0	1	04	01	H2775_105_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								85.00		255.00					75.00		225.00											85.00		255.00				75.00		150.00				85.00				85.00			2.83	2.5		2.83	2.5	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	105	0	1	04	01	H2775_105_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	106	0	1	04	01	H2775_106_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	106	0	1	04	01	H2775_106_0	3		N	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H2775	106	0	1	04	01	H2775_106_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	106	0	1	04	01	H2775_106_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	106	0	1	04	01	H2775_106_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	106	0	1	04	01	H2775_106_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	109	0	1	04	01	H2775_109_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	109	0	1	04	01	H2775_109_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.3	0.13		0.3	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	109	0	1	04	01	H2775_109_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	109	0	1	04	01	H2775_109_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	109	0	1	04	01	H2775_109_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	111	0	1	04	01	H2775_111_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	111	0	1	04	01	H2775_111_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H2775	111	0	1	04	01	H2775_111_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	111	0	1	04	01	H2775_111_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	111	0	1	04	01	H2775_111_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	111	0	1	04	01	H2775_111_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	112	0	1	04	01	H2775_112_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	112	0	1	04	01	H2775_112_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	112	0	1	04	01	H2775_112_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	112	0	1	04	01	H2775_112_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				96.77	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	112	0	1	04	01	H2775_112_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	113	0	1	04	01	H2775_113_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	113	0	1	04	01	H2775_113_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	113	0	1	04	01	H2775_113_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	113	0	1	04	01	H2775_113_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.49	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	113	0	1	04	01	H2775_113_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	002	0	1	01	01	H2782_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	002	0	1	01	01	H2782_002_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2782	002	0	1	01	01	H2782_002_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					10.00	20.00	25.00																10.00				10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	002	0	1	01	01	H2782_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	002	0	1	01	01	H2782_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	250.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	002	0	1	01	01	H2782_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	003	0	1	01	01	H2782_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	003	0	1	01	01	H2782_003_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2782	003	0	1	01	01	H2782_003_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					10.00	20.00	25.00																10.00				10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	003	0	1	01	01	H2782_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	112.50																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	003	0	1	01	01	H2782_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	250.00																100.00				100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2782	003	0	1	01	01	H2782_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	003	0	1	01	01	H2793_003_0	8		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	003	0	1	01	01	H2793_003_0	8		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2793	003	0	1	01	01	H2793_003_0	8		N	Generic	4	11	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	003	0	1	01	01	H2793_003_0	8		N	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2793	003	0	1	01	01	H2793_003_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	003	0	1	01	01	H2793_003_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	003	0	1	01	01	H2793_003_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1035.24	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	9		N	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	9		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2793	004	0	1	01	01	H2793_004_0	9		N	Generic	4	11	3	1	2	1	110		01	100		1	30		90				1	2			90				30		31				9.92	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	9		N	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2793	004	0	1	01	01	H2793_004_0	9		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				75.94	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				75.50	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	004	0	1	01	01	H2793_004_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				738.45	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2793	005	0	1	01	01	H2793_005_0	8		Y	Generic	4	11	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H2793	005	0	1	01	01	H2793_005_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1175.79	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	005	0	1	01	01	H2793_005_0	8		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	3.00		6.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2793	007	0	1	01	01	H2793_007_0	10		N	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	007	0	1	01	01	H2793_007_0	10		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2793	007	0	1	01	01	H2793_007_0	10		N	Generic	4	11	3	1	2	1	110		01	100		1	30		90				1	2			90				30		31				9.98	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	007	0	1	01	01	H2793_007_0	10		N	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H2793	007	0	1	01	01	H2793_007_0	10		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				76.78	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	007	0	1	01	01	H2793_007_0	10		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				76.03	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2793	007	0	1	01	01	H2793_007_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				739.05	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	001	0	1	02	01	H2802_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	02	01	H2802_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				239.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	007	0	1	02	01	H2802_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	02	01	H2802_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				281.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	008	0	1	02	01	H2802_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	02	01	H2802_008_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				228.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	010	0	1	02	01	H2802_010_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	02	01	H2802_010_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				327.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	012	0	1	02	01	H2802_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	02	01	H2802_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				366.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	02	01	H2802_015_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	02	01	H2802_015_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	02	01	H2802_015_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	015	0	1	02	01	H2802_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	02	01	H2802_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	02	01	H2802_015_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				342.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	016	0	1	02	01	H2802_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	02	01	H2802_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				309.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	018	0	1	02	01	H2802_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	02	01	H2802_018_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				270.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	020	0	1	02	01	H2802_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	02	01	H2802_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				240.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	024	0	1	01	01	H2802_024_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				400.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	025	0	1	01	01	H2802_025_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				277.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	026	0	1	01	01	H2802_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				322.00	32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	028	0	1	02	01	H2802_028_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	02	01	H2802_028_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				428.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	029	0	1	02	01	H2802_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	02	01	H2802_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				361.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	030	0	1	02	01	H2802_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	02	01	H2802_030_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				397.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		8.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		28.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		28.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	031	0	1	02	01	H2802_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	02	01	H2802_031_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				404.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		8.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	15.00		30.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	15.00		30.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	032	0	1	02	01	H2802_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	02	01	H2802_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				441.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		8.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		28.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		28.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	033	0	1	02	01	H2802_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	02	01	H2802_033_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				494.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	034	0	1	02	01	H2802_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	02	01	H2802_034_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				489.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	035	0	1	02	01	H2802_035_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	02	01	H2802_035_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				384.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	041	0	1	01	01	H2802_041_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				406.00	32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	048	0	1	01	01	H2802_048_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	048	0	1	01	01	H2802_048_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				307.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H2802	049	0	1	02	01	H2802_049_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	049	0	1	02	01	H2802_049_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				433.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	3			Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	3			Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	3			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					35.00		105.00											45.00		135.00				35.00		70.00				45.00				45.00			1.5	1.17		1.5	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	3			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								85.00		255.00					75.00		225.00											85.00		255.00				75.00		150.00				85.00				85.00			2.83	2.5		2.83	2.5	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	3			Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.2	0.03		0.2	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	3			Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	3			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	3			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	001	0	1	01	01	H2825_001_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					0.00	0.00	0.00																4.00				4.00			0.13	0.00	0.00			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	001	0	1	01	01	H2825_001_0	7		N	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					0.00	0.00	0.00																12.00				12.00			0.40	0.00	0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	001	0	1	01	01	H2825_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								44.00	88.00	132.00					39.00	78.00	117.00					39.00	78.00	117.00																44.00				44.00			1.47	1.30	1.30			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	001	0	1	01	01	H2825_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	270.00																95.00				95.00			3.17	3.00	3.00			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	001	0	1	01	01	H2825_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											851.19	33						851.19	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	002	0	1	01	01	H2825_002_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	6.00																12.00				12.00			0.40	0.07	0.07			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	002	0	1	01	01	H2825_002_0	7		N	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	51.00					7.00	14.00	21.00					7.00	14.00	21.00																17.00				17.00			0.57	0.23	0.23			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	002	0	1	01	01	H2825_002_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	002	0	1	01	01	H2825_002_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2825	002	0	1	01	01	H2825_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											851.19	33						851.19	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2829	001	0	1	01	01	H2829_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2829	001	0	1	01	01	H2829_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2829	001	0	1	01	01	H2829_001_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2829	001	0	1	01	01	H2829_001_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2829	001	0	1	01	01	H2829_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2829	001	0	1	01	01	H2829_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2829	001	0	1	01	01	H2829_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											530.76	29						445.90	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H2836	005	0	1	04	01	H2836_005_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	005	0	1	04	01	H2836_005_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	005	0	1	04	01	H2836_005_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	005	0	1	04	01	H2836_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	005	0	1	04	01	H2836_005_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	005	0	1	04	01	H2836_005_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2836	005	0	1	04	01	H2836_005_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2853	001	0	1	01	01	H2853_001_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	001	0	1	01	01	H2853_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2853	002	0	1	01	01	H2853_002_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2879	001	0	1	01	01	H2879_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.51	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				465.01	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	001	0	1	01	01	H2915_001_0	4		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	001	0	1	01	01	H2915_001_0	4		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	001	0	1	01	01	H2915_001_0	4		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	001	0	1	01	01	H2915_001_0	4		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				72.00	42	42	42																		42	42	42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	001	0	1	01	01	H2915_001_0	4		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	002	0	1	01	01	H2915_002_0	4		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	002	0	1	01	01	H2915_002_0	4		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	002	0	1	01	01	H2915_002_0	4		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	002	0	1	01	01	H2915_002_0	4		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				77.00	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	002	0	1	01	01	H2915_002_0	4		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	003	0	1	01	01	H2915_003_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	003	0	1	01	01	H2915_003_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	007	0	1	01	01	H2915_007_0	3		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	007	0	1	01	01	H2915_007_0	3		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	007	0	1	01	01	H2915_007_0	3		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	007	0	1	01	01	H2915_007_0	3		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				95.00	48	48	48																		48	48	48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	007	0	1	01	01	H2915_007_0	3		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	011	0	1	01	01	H2915_011_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	011	0	1	01	01	H2915_011_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	011	0	1	01	01	H2915_011_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	011	0	1	01	01	H2915_011_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	011	0	1	01	01	H2915_011_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2915	012	0	1	01	01	H2915_012_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	012	0	1	01	01	H2915_012_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	014	0	1	01	01	H2915_014_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	014	0	1	01	01	H2915_014_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	014	0	1	01	01	H2915_014_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	014	0	1	01	01	H2915_014_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	014	0	1	01	01	H2915_014_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	014	0	1	01	01	H2915_014_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	2	1	01	01	H2915_015_2	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	2	1	01	01	H2915_015_2	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	2	1	01	01	H2915_015_2	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	2	1	01	01	H2915_015_2	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	2	1	01	01	H2915_015_2	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	2	1	01	01	H2915_015_2	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	3	1	01	01	H2915_015_3	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	3	1	01	01	H2915_015_3	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	3	1	01	01	H2915_015_3	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	3	1	01	01	H2915_015_3	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	3	1	01	01	H2915_015_3	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2915	015	3	1	01	01	H2915_015_3	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2944	013	0	1	09	04	H2944_013_0	3			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	3			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	3			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	3			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	5			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	5			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	5			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	5			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	5			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								11.00		27.50					5.00		12.50							10.00																11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		50.00					12.00		30.00							24.00																20.00				20.00			0.67	0.40				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	5		N	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		117.50					41.00		102.50							82.00																47.00				47.00			1.57	1.37				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		250.00					94.00		235.00							188.00																100.00				100.00			3.33	3.13				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	5		N	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		100	1	2			100				30		31								8.50		21.25					2.50		6.25							5.00																8.50				8.50			0.28	0.08				0.27	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	012	0	1	01	01	H2960_012_0	5		N	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		100	1	2			100				30		31								8.50		21.25					2.50		6.25							0.00																8.50				2.50			0.28	0.08				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	018	0	1	01	01	H2960_018_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								6.00		15.00					0.00		0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	5		Y	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								6.00		15.00					0.00		0.00							0.00																0.00				0.00			0.20	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	018	0	1	01	01	H2960_018_0	5		Y	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		20.00					0.00		0.00							0.00																8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	5		Y	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		20.00					0.00		0.00							0.00																0.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	018	0	1	01	01	H2960_018_0	5		Y	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		117.50					41.00		102.50							82.00																47.00				47.00			1.57	1.37				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		250.00					94.00		235.00							188.00																100.00				100.00			3.33	3.13				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		100	1	2			100				30		31								6.00		15.00					0.00		0.00							0.00																6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	018	0	1	01	01	H2960_018_0	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		100	1	2			100				30		31								6.00		15.00					0.00		0.00							0.00																0.00				0.00			0.20	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	019	0	1	01	01	H2960_019_0	4		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								8.00		20.00					2.00		5.00							0.00																2.00				2.00			0.27	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	4		N	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								8.00		20.00					2.00		5.00							0.00																2.00				2.00			0.27	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	019	0	1	01	01	H2960_019_0	4		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		40.00					8.00		20.00							16.00																8.00				8.00			0.53	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	4		N	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								16.00		40.00					8.00		20.00							16.00																8.00				8.00			0.53	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	019	0	1	01	01	H2960_019_0	4		N	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		117.50					41.00		102.50							94.00																47.00				47.00			1.57	1.37				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	4		N	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		250.00					94.00		235.00							200.00																100.00				100.00			3.33	3.13				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	4		N	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		100	1	2			100				30		31								6.00		15.00					0.00		0.00							0.00																0.00				0.00			0.20	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	019	0	1	01	01	H2960_019_0	4		N	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		100	1	2			100				30		31								6.00		15.00					0.00		0.00							0.00																0.00				0.00			0.20	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	021	0	1	01	01	H2960_021_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								8.00		20.00					2.00		5.00							0.00																2.00				2.00			0.27	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	021	0	1	01	01	H2960_021_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								8.00		20.00					2.00		5.00							0.00																2.00				2.00			0.27	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	021	0	1	01	01	H2960_021_0	6		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								16.00		40.00					8.00		20.00							16.00																8.00				8.00			0.53	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	021	0	1	01	01	H2960_021_0	6		N	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								16.00		40.00					8.00		20.00							16.00																8.00				8.00			0.53	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	021	0	1	01	01	H2960_021_0	6		N	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		117.50					41.00		102.50							94.00																47.00				47.00			1.57	1.37				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	021	0	1	01	01	H2960_021_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		250.00					94.00		235.00							200.00																100.00				100.00			3.33	3.13				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	021	0	1	01	01	H2960_021_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	021	0	1	01	01	H2960_021_0	6		N	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		100	1	2			100				30		31								6.00		15.00					0.00		0.00							0.00																0.00				0.00			0.20	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	021	0	1	01	01	H2960_021_0	6		N	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		100	1	2			100				30		31								6.00		15.00					0.00		0.00							0.00																0.00				0.00			0.20	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	022	0	1	01	01	H2960_022_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								8.00		20.00					0.00		0.00							0.00																8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	022	0	1	01	01	H2960_022_0	8		Y	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								8.00		20.00					0.00		0.00							0.00																8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	022	0	1	01	01	H2960_022_0	8		Y	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		37.50					5.00		12.50							10.00																15.00				15.00			0.50	0.17				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	022	0	1	01	01	H2960_022_0	8		Y	Generic	4	01	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		37.00					5.00		12.50							10.00																15.00				15.00			0.50	0.17				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	022	0	1	01	01	H2960_022_0	8		Y	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		117.50					37.00		92.50							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	022	0	1	01	01	H2960_022_0	8		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		237.50					85.00		212.50							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	022	0	1	01	01	H2960_022_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	022	0	1	01	01	H2960_022_0	8		Y	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		100	1	2			100				30		31								8.00		20.00					0.00		0.00							0.00																8.00				8.00			0.26	0.00				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	022	0	1	01	01	H2960_022_0	8		Y	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		100	1	2			100				30		31								8.00		20.00					0.00		0.00							0.00																8.00				8.00			0.26	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2960	023	0	1	01	01	H2960_023_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								11.00		27.50					5.00		12.50							10.00																11.00				11.00			0.37	0.17				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		50.00					12.00		30.00							24.00																20.00				20.00			0.67	0.40				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	5		N	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		117.50					41.00		102.50							82.00																47.00				47.00			1.57	1.37				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		250.00					94.00		235.00							188.00																100.00				100.00			3.33	3.13				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	5		N	Select Care Drugs	4	01	1	2	6	1		110	01	100		1				30		100	1	2			100				30		31								8.50		21.25					2.50		6.25							5.00																8.50				8.50			0.28	0.08				0.27	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2960	023	0	1	01	01	H2960_023_0	5		N	Select Care Drugs	4	01	1	2	6	3		110	01	100		1				30		100	1	2			100				30		31								8.50		21.25					2.50		6.25							0.00																8.50				8.50			0.28	0.08				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2962	001	0	1	01	01	H2962_001_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	001	0	1	01	01	H2962_001_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				792.89	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	011	0	1	01	01	H2962_011_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	011	0	1	01	01	H2962_011_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	011	0	1	01	01	H2962_011_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	011	0	1	01	01	H2962_011_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	011	0	1	01	01	H2962_011_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				743.28	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	012	0	1	01	01	H2962_012_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	012	0	1	01	01	H2962_012_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	012	0	1	01	01	H2962_012_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	012	0	1	01	01	H2962_012_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	50.00	100.00	150.00																					100.00																50.00				50.00		1.67						1.61	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	012	0	1	01	01	H2962_012_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				814.77	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	013	3	1	01	01	H2962_013_3	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	3	1	01	01	H2962_013_3	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				536.19	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	013	4	1	01	01	H2962_013_4	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	013	4	1	01	01	H2962_013_4	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				536.19	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	1	1	01	01	H2962_014_1	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	1	1	01	01	H2962_014_1	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	014	1	1	01	01	H2962_014_1	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	1	1	01	01	H2962_014_1	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	50.00	100.00	150.00																					100.00																50.00				50.00		1.67						1.61	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	1	1	01	01	H2962_014_1	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				935.36	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	2	1	01	01	H2962_014_2	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	2	1	01	01	H2962_014_2	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	014	2	1	01	01	H2962_014_2	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	2	1	01	01	H2962_014_2	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	50.00	100.00	150.00																					100.00																50.00				50.00		1.67						1.61	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	014	2	1	01	01	H2962_014_2	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				935.36	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	016	0	1	01	01	H2962_016_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	016	0	1	01	01	H2962_016_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	016	0	1	01	01	H2962_016_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	30.00	60.00	90.00																					60.00																30.00				30.00		1.00						0.97	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	016	0	1	01	01	H2962_016_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	70.00	140.00	210.00																					140.00																70.00				70.00		2.33						2.26	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	016	0	1	01	01	H2962_016_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				809.31	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	019	1	1	01	01	H2962_019_1	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	019	1	1	01	01	H2962_019_1	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				1035.21	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	1	1	01	01	H2962_019_1	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	019	2	1	01	01	H2962_019_2	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	019	2	1	01	01	H2962_019_2	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				1035.21	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	019	2	1	01	01	H2962_019_2	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	021	0	1	01	01	H2962_021_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	021	0	1	01	01	H2962_021_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				1037.05	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	021	0	1	01	01	H2962_021_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	022	0	1	01	01	H2962_022_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	022	0	1	01	01	H2962_022_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				1105.30	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	022	0	1	01	01	H2962_022_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	023	0	1	01	01	H2962_023_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	023	0	1	01	01	H2962_023_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				823.99	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	023	0	1	01	01	H2962_023_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	024	0	1	01	01	H2962_024_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	024	0	1	01	01	H2962_024_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				1102.88	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	024	0	1	01	01	H2962_024_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	025	0	1	01	01	H2962_025_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	025	0	1	01	01	H2962_025_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				822.13	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	025	0	1	01	01	H2962_025_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	026	0	1	01	01	H2962_026_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	026	0	1	01	01	H2962_026_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				1044.74	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	026	0	1	01	01	H2962_026_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	027	0	1	01	01	H2962_027_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	027	0	1	01	01	H2962_027_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	027	0	1	01	01	H2962_027_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	027	0	1	01	01	H2962_027_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	027	0	1	01	01	H2962_027_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				820.91	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	027	0	1	01	01	H2962_027_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	027	0	1	01	01	H2962_027_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	028	0	1	01	01	H2962_028_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	028	0	1	01	01	H2962_028_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	028	0	1	01	01	H2962_028_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	028	0	1	01	01	H2962_028_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	028	0	1	01	01	H2962_028_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				653.01	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	029	0	1	01	01	H2962_029_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	029	0	1	01	01	H2962_029_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				1051.49	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	029	0	1	01	01	H2962_029_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	030	0	1	01	01	H2962_030_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	030	0	1	01	01	H2962_030_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	030	0	1	01	01	H2962_030_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	030	0	1	01	01	H2962_030_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	030	0	1	01	01	H2962_030_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				827.64	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	030	0	1	01	01	H2962_030_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	030	0	1	01	01	H2962_030_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	031	0	1	01	01	H2962_031_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	031	0	1	01	01	H2962_031_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	031	0	1	01	01	H2962_031_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	105.00																					70.00																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	031	0	1	01	01	H2962_031_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	031	0	1	01	01	H2962_031_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				642.90	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2962	032	0	1	01	01	H2962_032_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	25.00	50.00	75.00																					50.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	50.00	100.00	150.00																					100.00																50.00				50.00		1.67						1.61	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	032	0	1	01	01	H2962_032_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				803.34	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2962	033	0	1	01	01	H2962_033_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	033	0	1	01	01	H2962_033_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				1041.10	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	033	0	1	01	01	H2962_033_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	034	0	1	01	01	H2962_034_0	9		Y	Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	9		Y	Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2962	034	0	1	01	01	H2962_034_0	9		Y	Preferred Brand	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	9		Y	Non-Preferred Drug	4	11	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	9		Y	Specialty Tier	4	11	1	1	4	1	010		01			1	30														30		31				817.35	33																																					33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	9		Y	Select Care Drugs	4	11	1	2	5	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2962	034	0	1	01	01	H2962_034_0	9		Y	Select Care Drugs	4	11	1	2	5	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2986	001	0	1	01	01	H2986_001_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	11		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	001	0	1	01	01	H2986_001_0	11		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	11		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				485.48	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	11		N	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	001	0	1	01	01	H2986_001_0	11		N	Select Care Drugs	4	01	1	2	6	3	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	002	0	1	01	01	H2986_002_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	10		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	002	0	1	01	01	H2986_002_0	10		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	10		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				501.33	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	10		N	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	002	0	1	01	01	H2986_002_0	10		N	Select Care Drugs	4	01	1	2	6	3	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	004	0	1	01	01	H2986_004_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	004	0	1	01	01	H2986_004_0	9		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	9		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				662.07	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	9		N	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	004	0	1	01	01	H2986_004_0	9		N	Select Care Drugs	4	01	1	2	6	3	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	006	0	1	01	01	H2986_006_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	006	0	1	01	01	H2986_006_0	10		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	006	0	1	01	01	H2986_006_0	10		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	006	0	1	01	01	H2986_006_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	006	0	1	01	01	H2986_006_0	10		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	006	0	1	01	01	H2986_006_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				983.57	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	006	0	1	01	01	H2986_006_0	10		N	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	006	0	1	01	01	H2986_006_0	10		N	Select Care Drugs	4	01	1	2	6	3	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	007	0	1	01	01	H2986_007_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	11		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2986	007	0	1	01	01	H2986_007_0	11		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	11		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				674.25	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	11		N	Select Care Drugs	4	01	1	2	6	1	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2986	007	0	1	01	01	H2986_007_0	11		N	Select Care Drugs	4	01	1	2	6	3	111		01	100		1	30	60	100				1	2			100				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3047	001	0	1	04	01	H3047_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	001	0	1	04	01	H3047_001_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H3047	001	0	1	04	01	H3047_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	001	0	1	04	01	H3047_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	001	0	1	04	01	H3047_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	001	0	1	04	01	H3047_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	002	0	1	04	01	H3047_002_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	002	0	1	04	01	H3047_002_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H3047	002	0	1	04	01	H3047_002_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	002	0	1	04	01	H3047_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	002	0	1	04	01	H3047_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3047	002	0	1	04	01	H3047_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10		Y	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																0.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10		Y	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		10.00					12.00		5.00					12.00		5.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1500.00	33		33				1500.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	10		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																0.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	10		N	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		10.00					12.00		5.00					12.00		5.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	003	0	1	02	01	H3071_003_0	10		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1500.00	33		33				1500.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3113	008	0	1	02	01	H3113_008_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	02	01	H3113_008_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				277.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3132	001	0	1	01	01	H3132_001_0	4		N	Generic	4	01	1	1	1	1	110		01			1	30		90				1	2							30		34				9.03	15		15																																			15			15								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3132	001	0	1	01	01	H3132_001_0	4		N	Preferred Brand	4	11	1	1	2	1	110		01			1	30		90				1	2							30		34				14.67	15		15																																			15			15								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3132	001	0	1	01	01	H3132_001_0	4		N	Non-Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				1	1							30		34				115.31	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3132	001	0	1	01	01	H3132_001_0	4		N	Specialty Tier	4	10	1	1	4	1	110		01			1	30		90				1	1							30		34				717.92	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3132	001	0	1	01	01	H3132_001_0	4		N	Select Care Drugs	4	01	1	1	5	1	110		01			1	30		90				1	2							30		34				0.00	0		0																																			0			0								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3132	001	0	1	01	01	H3132_001_0	4		N	Select Care Drugs	4	01	1	1	5	3	110		01			1	30		90				1	2							30		34				0.00	0		0																																			0			0								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3146	001	0	1	01	01	H3146_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	001	0	1	01	01	H3146_001_0	6		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	001	0	1	01	01	H3146_001_0	6		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	001	0	1	01	01	H3146_001_0	6		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	001	0	1	01	01	H3146_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	001	0	1	01	01	H3146_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	001	0	1	01	01	H3146_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											769.29	33						564.44	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	002	0	1	01	01	H3146_002_0	8		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	002	0	1	01	01	H3146_002_0	8		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	002	0	1	01	01	H3146_002_0	8		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	002	0	1	01	01	H3146_002_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	002	0	1	01	01	H3146_002_0	8		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				493.41	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	003	0	1	01	01	H3146_003_0	8		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	003	0	1	01	01	H3146_003_0	8		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	003	0	1	01	01	H3146_003_0	8		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	003	0	1	01	01	H3146_003_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	003	0	1	01	01	H3146_003_0	8		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				519.55	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	004	0	1	01	01	H3146_004_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	004	0	1	01	01	H3146_004_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	004	0	1	01	01	H3146_004_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	004	0	1	01	01	H3146_004_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	004	0	1	01	01	H3146_004_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	004	0	1	01	01	H3146_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	004	0	1	01	01	H3146_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											742.46	33						544.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	005	0	1	01	01	H3146_005_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	005	0	1	01	01	H3146_005_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	005	0	1	01	01	H3146_005_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	005	0	1	01	01	H3146_005_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	005	0	1	01	01	H3146_005_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	005	0	1	01	01	H3146_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	005	0	1	01	01	H3146_005_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											695.09	29						504.70	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	006	0	1	01	01	H3146_006_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	006	0	1	01	01	H3146_006_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	006	0	1	01	01	H3146_006_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	006	0	1	01	01	H3146_006_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	006	0	1	01	01	H3146_006_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	006	0	1	01	01	H3146_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	006	0	1	01	01	H3146_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											786.08	29						560.34	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	007	0	1	01	01	H3146_007_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	007	0	1	01	01	H3146_007_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	007	0	1	01	01	H3146_007_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	007	0	1	01	01	H3146_007_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	007	0	1	01	01	H3146_007_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	007	0	1	01	01	H3146_007_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	007	0	1	01	01	H3146_007_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											789.82	33						577.36	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	008	0	1	01	01	H3146_008_0	8		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	008	0	1	01	01	H3146_008_0	8		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	008	0	1	01	01	H3146_008_0	8		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	008	0	1	01	01	H3146_008_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	008	0	1	01	01	H3146_008_0	8		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				498.18	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	009	0	1	01	01	H3146_009_0	8		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	009	0	1	01	01	H3146_009_0	8		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	009	0	1	01	01	H3146_009_0	8		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	009	0	1	01	01	H3146_009_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	009	0	1	01	01	H3146_009_0	8		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				505.77	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	010	0	1	01	01	H3146_010_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	010	0	1	01	01	H3146_010_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	010	0	1	01	01	H3146_010_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	010	0	1	01	01	H3146_010_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	010	0	1	01	01	H3146_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	010	0	1	01	01	H3146_010_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	010	0	1	01	01	H3146_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											644.66	29						470.38	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	011	0	1	01	01	H3146_011_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	011	0	1	01	01	H3146_011_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	011	0	1	01	01	H3146_011_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	011	0	1	01	01	H3146_011_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	011	0	1	01	01	H3146_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	011	0	1	01	01	H3146_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	011	0	1	01	01	H3146_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											678.46	28						489.01	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	012	0	1	01	01	H3146_012_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	012	0	1	01	01	H3146_012_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	012	0	1	01	01	H3146_012_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	012	0	1	01	01	H3146_012_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	012	0	1	01	01	H3146_012_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	012	0	1	01	01	H3146_012_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	012	0	1	01	01	H3146_012_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											696.59	28						500.64	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	013	0	1	01	01	H3146_013_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	013	0	1	01	01	H3146_013_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	013	0	1	01	01	H3146_013_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	013	0	1	01	01	H3146_013_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3146	013	0	1	01	01	H3146_013_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	013	0	1	01	01	H3146_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3146	013	0	1	01	01	H3146_013_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											581.03	28						426.37	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	022	0	1	01	01	H3152_022_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	022	0	1	01	01	H3152_022_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	022	0	1	01	01	H3152_022_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	022	0	1	01	01	H3152_022_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	022	0	1	01	01	H3152_022_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	022	0	1	01	01	H3152_022_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	022	0	1	01	01	H3152_022_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											518.43	31						441.97	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	048	0	1	01	01	H3152_048_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	048	0	1	01	01	H3152_048_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	048	0	1	01	01	H3152_048_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	048	0	1	01	01	H3152_048_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	048	0	1	01	01	H3152_048_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	048	0	1	01	01	H3152_048_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	048	0	1	01	01	H3152_048_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											656.33	31						532.93	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	080	0	1	01	01	H3152_080_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	080	0	1	01	01	H3152_080_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	080	0	1	01	01	H3152_080_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	080	0	1	01	01	H3152_080_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	080	0	1	01	01	H3152_080_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	080	0	1	01	01	H3152_080_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	080	0	1	01	01	H3152_080_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											614.91	29						297.15	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	082	0	1	01	01	H3152_082_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	082	0	1	01	01	H3152_082_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	082	0	1	01	01	H3152_082_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	082	0	1	01	01	H3152_082_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	082	0	1	01	01	H3152_082_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	082	0	1	01	01	H3152_082_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	082	0	1	01	01	H3152_082_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											635.85	29						393.78	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	084	0	1	01	01	H3152_084_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	084	0	1	01	01	H3152_084_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	084	0	1	01	01	H3152_084_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	084	0	1	01	01	H3152_084_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	084	0	1	01	01	H3152_084_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	084	0	1	01	01	H3152_084_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	084	0	1	01	01	H3152_084_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											641.07	31						369.56	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	088	0	1	01	01	H3152_088_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	088	0	1	01	01	H3152_088_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	088	0	1	01	01	H3152_088_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	088	0	1	01	01	H3152_088_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	088	0	1	01	01	H3152_088_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	088	0	1	01	01	H3152_088_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	088	0	1	01	01	H3152_088_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											481.03	27						344.08	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	092	0	1	01	01	H3152_092_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	092	0	1	01	01	H3152_092_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	092	0	1	01	01	H3152_092_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	092	0	1	01	01	H3152_092_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	092	0	1	01	01	H3152_092_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	092	0	1	01	01	H3152_092_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3152	092	0	1	01	01	H3152_092_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											609.43	28						451.83	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3154	004	0	1	01	01	H3154_004_0	10		N	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					1.00	2.00	3.00																9.00				9.00			0.30	0.07	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	10		N	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					6.00	12.00	18.00																20.00				20.00			0.67	0.40	0.20			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	10		N	Preferred Brand	2	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					35.00	70.00	105.00					35.00	70.00	105.00																42.00				42.00			1.40	1.17	1.17			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	10		N	Non-Preferred Drug	2	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								75.00	150.00	225.00					65.00	130.00	195.00					65.00	130.00	195.00																75.00				75.00			2.50	2.17	2.17			2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	10		N	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											368.26	25						368.26	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8		N	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					1.00	2.00	3.00																9.00				9.00			0.30	0.07	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8		N	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					6.00	12.00	18.00																20.00				20.00			0.67	0.40	0.20			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8		N	Preferred Brand	2	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					35.00	70.00	105.00					35.00	70.00	105.00																42.00				42.00			1.40	1.17	1.17			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8		N	Non-Preferred Drug	2	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								75.00	150.00	225.00					65.00	130.00	195.00					65.00	130.00	195.00																75.00				75.00			2.50	2.17	2.17			2.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8		N	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											284.13	25						284.13	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_0	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											57.78	40	40	40				50.56	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	029	0	1	01	01	H3154_029_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											441.99	28						441.99	28																							28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											60.87	40	40	40				53.27	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	030	0	1	01	01	H3154_030_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											435.17	28						435.17	28																							28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											48.63	40	40	40				42.55	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	031	0	1	01	01	H3154_031_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											510.95	29						510.95	29																							29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					0.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											60.82	40	40	40				53.22	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	032	0	1	01	01	H3154_032_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											615.53	33						615.53	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					.50	1.00	1.50																8.00				8.00			0.27	0.03	0.02			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_0	9		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					4.50	9.00	13.50																16.00				16.00			0.53	0.30	0.15			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_0	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											59.39	40	40	40				51.97	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	033	0	1	02	01	H3154_033_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											489.09	33						489.09	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	0.00																12.00				2.00			0.40	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					8.00	16.00	24.00					8.00	16.00	0.00																18.00				8.00			0.60	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				37.00			1.57	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					3.00	6.00	9.00					4.00	8.00	0.00																14.00				3.00			0.47	0.10	0.13			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					8.00	16.00	24.00					8.00	16.00	0.00																18.00				8.00			0.60	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				37.00			1.57	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	1	1	01	01	H3170_003_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	28						1.00	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					3.00	6.00	9.00					4.00	8.00	0.00																14.00				3.00			0.47	0.10	0.13			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					8.00	16.00	24.00					8.00	16.00	0.00																18.00				8.00			0.60	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				37.00			1.57	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3170	003	2	1	01	01	H3170_003_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	28						1.00	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3192	001	0	1	01	01	H3192_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	001	0	1	01	01	H3192_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	001	0	1	01	01	H3192_001_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	001	0	1	01	01	H3192_001_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	001	0	1	01	01	H3192_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	001	0	1	01	01	H3192_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	001	0	1	01	01	H3192_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											677.80	33						500.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	002	0	1	01	01	H3192_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	002	0	1	01	01	H3192_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	002	0	1	01	01	H3192_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	002	0	1	01	01	H3192_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	002	0	1	01	01	H3192_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	002	0	1	01	01	H3192_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	002	0	1	01	01	H3192_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											714.25	33						521.72	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	003	0	1	01	01	H3192_003_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	003	0	1	01	01	H3192_003_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	003	0	1	01	01	H3192_003_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	003	0	1	01	01	H3192_003_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	003	0	1	01	01	H3192_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	003	0	1	01	01	H3192_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	003	0	1	01	01	H3192_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											717.21	33						523.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	004	0	1	01	01	H3192_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	004	0	1	01	01	H3192_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	004	0	1	01	01	H3192_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	004	0	1	01	01	H3192_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	004	0	1	01	01	H3192_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	004	0	1	01	01	H3192_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	004	0	1	01	01	H3192_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											767.51	33						561.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	005	0	1	01	01	H3192_005_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	005	0	1	01	01	H3192_005_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	005	0	1	01	01	H3192_005_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	005	0	1	01	01	H3192_005_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	005	0	1	01	01	H3192_005_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	005	0	1	01	01	H3192_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	005	0	1	01	01	H3192_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											620.86	33						473.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	006	0	1	01	01	H3192_006_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	006	0	1	01	01	H3192_006_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	006	0	1	01	01	H3192_006_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	006	0	1	01	01	H3192_006_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3192	006	0	1	01	01	H3192_006_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	006	0	1	01	01	H3192_006_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	006	0	1	01	01	H3192_006_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											712.42	33						524.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	007	0	1	01	01	H3192_007_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	007	0	1	01	01	H3192_007_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	007	0	1	01	01	H3192_007_0	5		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											30.64	25	25	25				32.33	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	007	0	1	01	01	H3192_007_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.32	35	35	35				50.27	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3192	007	0	1	01	01	H3192_007_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											484.00	29						384.25	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3204	001	0	1	01	01	H3204_001_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01		111	1	30	60	90				2	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	7		Y	Generic	4	01	1	2	2	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Generic	4	01	1	2	2	3	111		01		111	1	30	60	90				2	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7		N	Preferred Generic	3	01	1	2	1	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7		N	Generic	3	01	1	2	2	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7		N	Preferred Brand	3	11	1	2	3	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7		N	Non-Preferred Drug	3	11	1	2	4	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7		N	Specialty Tier	3	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3213	011	0	1	01	01	H3213_011_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	011	0	1	01	01	H3213_011_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	011	0	1	01	01	H3213_011_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	011	0	1	01	01	H3213_011_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	011	0	1	01	01	H3213_011_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	011	0	1	01	01	H3213_011_0	4		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	012	0	1	01	01	H3213_012_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	012	0	1	01	01	H3213_012_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	012	0	1	01	01	H3213_012_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	012	0	1	01	01	H3213_012_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	012	0	1	01	01	H3213_012_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	012	0	1	01	01	H3213_012_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	013	0	1	01	01	H3213_013_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	013	0	1	01	01	H3213_013_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	013	0	1	01	01	H3213_013_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	013	0	1	01	01	H3213_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	013	0	1	01	01	H3213_013_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	013	0	1	01	01	H3213_013_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	014	0	1	01	01	H3213_014_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	014	0	1	01	01	H3213_014_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	014	0	1	01	01	H3213_014_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	014	0	1	01	01	H3213_014_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	014	0	1	01	01	H3213_014_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	014	0	1	01	01	H3213_014_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	015	0	1	01	01	H3213_015_0	3		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.67	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	015	0	1	01	01	H3213_015_0	3		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.63	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	015	0	1	01	01	H3213_015_0	3		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				86.60	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	015	0	1	01	01	H3213_015_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.82	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	015	0	1	01	01	H3213_015_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				446.81	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	015	0	1	01	01	H3213_015_0	3		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	016	0	1	01	01	H3213_016_0	3		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.67	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	016	0	1	01	01	H3213_016_0	3		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.63	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	016	0	1	01	01	H3213_016_0	3		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				86.60	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	016	0	1	01	01	H3213_016_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.82	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	016	0	1	01	01	H3213_016_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				446.58	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3213	016	0	1	01	01	H3213_016_0	3		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3219	001	0	1	04	01	H3219_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	001	0	1	04	01	H3219_001_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	001	0	1	04	01	H3219_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	001	0	1	04	01	H3219_001_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	001	0	1	04	01	H3219_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	001	0	1	04	01	H3219_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	001	0	1	04	01	H3219_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											846.37	28						615.66	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	002	0	1	04	01	H3219_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	002	0	1	04	01	H3219_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	002	0	1	04	01	H3219_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	002	0	1	04	01	H3219_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	002	0	1	04	01	H3219_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	002	0	1	04	01	H3219_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	002	0	1	04	01	H3219_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											736.59	30						551.19	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	003	0	1	04	01	H3219_003_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	003	0	1	04	01	H3219_003_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	003	0	1	04	01	H3219_003_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	003	0	1	04	01	H3219_003_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	003	0	1	04	01	H3219_003_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	003	0	1	04	01	H3219_003_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	003	0	1	04	01	H3219_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1026.37	33						739.98	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	004	0	1	04	01	H3219_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	004	0	1	04	01	H3219_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	004	0	1	04	01	H3219_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	004	0	1	04	01	H3219_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3219	004	0	1	04	01	H3219_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	004	0	1	04	01	H3219_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3219	004	0	1	04	01	H3219_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1037.85	33						734.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3237	001	0	1	48	05	H3237_001_0	3			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.70	0.00	3.70	0.00	3.70	0.00	3.70			
H3237	001	0	1	48	05	H3237_001_0	3			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.20	0.00	9.20	0.00	9.20	0.00	9.20			
H3237	001	0	1	48	05	H3237_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3237	002	0	1	48	05	H3237_002_0	3			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.70	0.00	3.70	0.00	3.70	0.00	3.70			
H3237	002	0	1	48	05	H3237_002_0	3			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.20	0.00	9.20	0.00	9.20	0.00	9.20			
H3237	002	0	1	48	05	H3237_002_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3239	001	0	1	01	01	H3239_001_0	10		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	001	0	1	01	01	H3239_001_0	10		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	001	0	1	01	01	H3239_001_0	10		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											27.57	25	25	25				28.09	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	001	0	1	01	01	H3239_001_0	10		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											52.07	35	35	35				45.62	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	001	0	1	01	01	H3239_001_0	10		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											433.88	29						327.05	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	002	0	1	01	01	H3239_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	002	0	1	01	01	H3239_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	002	0	1	01	01	H3239_002_0	2		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.65	25	25	25				29.38	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	002	0	1	01	01	H3239_002_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.91	35	35	35				49.06	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	002	0	1	01	01	H3239_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											489.36	29						382.86	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	003	0	1	01	01	H3239_003_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	003	0	1	01	01	H3239_003_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	003	0	1	01	01	H3239_003_0	2		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.66	25	25	25				29.38	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	003	0	1	01	01	H3239_003_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.93	35	35	35				49.08	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	003	0	1	01	01	H3239_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											491.92	29						384.51	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	005	0	1	01	01	H3239_005_0	7		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	005	0	1	01	01	H3239_005_0	7		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	005	0	1	01	01	H3239_005_0	7		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	005	0	1	01	01	H3239_005_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	005	0	1	01	01	H3239_005_0	7		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				421.18	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	006	0	1	01	01	H3239_006_0	7		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	006	0	1	01	01	H3239_006_0	7		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	006	0	1	01	01	H3239_006_0	7		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	006	0	1	01	01	H3239_006_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	006	0	1	01	01	H3239_006_0	7		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				469.61	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	007	0	1	01	01	H3239_007_0	7		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	007	0	1	01	01	H3239_007_0	7		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	007	0	1	01	01	H3239_007_0	7		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	007	0	1	01	01	H3239_007_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3239	007	0	1	01	01	H3239_007_0	7		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				474.21	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3240	013	0	1	01	01	H3240_013_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3240	021	0	1	01	01	H3240_021_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	021	0	1	01	01	H3240_021_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3240	022	0	1	01	01	H3240_022_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	022	0	1	01	01	H3240_022_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	022	0	1	01	01	H3240_022_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	022	0	1	01	01	H3240_022_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	022	0	1	01	01	H3240_022_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	022	0	1	01	01	H3240_022_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	022	0	1	01	01	H3240_022_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3240	024	0	1	02	01	H3240_024_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								43.00	86.00	129.00					43.00	86.00	129.00					43.00	129.00	129.00																43.00				43.00			1.43	1.43	1.43			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	024	0	1	02	01	H3240_024_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3251	002	0	1	01	01	H3251_002_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	5		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3251	002	0	1	01	01	H3251_002_0	5		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	5		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												30		30					30		30												30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3281	001	0	1	04	01	H3281_001_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	001	0	1	04	01	H3281_001_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	001	0	1	04	01	H3281_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	001	0	1	04	01	H3281_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	001	0	1	04	01	H3281_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				761.01	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	001	0	1	04	01	H3281_001_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	001	0	1	04	01	H3281_001_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3281	003	0	1	04	01	H3281_003_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	003	0	1	04	01	H3281_003_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	003	0	1	04	01	H3281_003_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	003	0	1	04	01	H3281_003_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	003	0	1	04	01	H3281_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				755.95	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	003	0	1	04	01	H3281_003_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	003	0	1	04	01	H3281_003_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3281	005	0	1	04	01	H3281_005_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	005	0	1	04	01	H3281_005_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	005	0	1	04	01	H3281_005_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	005	0	1	04	01	H3281_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	005	0	1	04	01	H3281_005_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				755.45	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	005	0	1	04	01	H3281_005_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	005	0	1	04	01	H3281_005_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3281	007	0	1	04	01	H3281_007_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	007	0	1	04	01	H3281_007_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	007	0	1	04	01	H3281_007_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	007	0	1	04	01	H3281_007_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	007	0	1	04	01	H3281_007_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				594.62	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	007	0	1	04	01	H3281_007_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	007	0	1	04	01	H3281_007_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3281	009	0	1	04	01	H3281_009_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	009	0	1	04	01	H3281_009_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	009	0	1	04	01	H3281_009_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	009	0	1	04	01	H3281_009_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	009	0	1	04	01	H3281_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				593.95	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	009	0	1	04	01	H3281_009_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	009	0	1	04	01	H3281_009_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3281	010	0	1	04	01	H3281_010_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	010	0	1	04	01	H3281_010_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	010	0	1	04	01	H3281_010_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	010	0	1	04	01	H3281_010_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	010	0	1	04	01	H3281_010_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				609.92	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	010	0	1	04	01	H3281_010_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	010	0	1	04	01	H3281_010_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3281	011	0	1	04	01	H3281_011_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	011	0	1	04	01	H3281_011_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		40.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	011	0	1	04	01	H3281_011_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	011	0	1	04	01	H3281_011_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	011	0	1	04	01	H3281_011_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				608.01	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	011	0	1	04	01	H3281_011_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3281	011	0	1	04	01	H3281_011_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3288	001	0	1	04	01	H3288_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	001	0	1	04	01	H3288_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	001	0	1	04	01	H3288_001_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	001	0	1	04	01	H3288_001_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	001	0	1	04	01	H3288_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	001	0	1	04	01	H3288_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	001	0	1	04	01	H3288_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											616.39	27						446.12	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	002	0	1	04	01	H3288_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	002	0	1	04	01	H3288_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	002	0	1	04	01	H3288_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	002	0	1	04	01	H3288_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	002	0	1	04	01	H3288_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	002	0	1	04	01	H3288_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	002	0	1	04	01	H3288_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											604.37	27						438.37	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	003	0	1	04	01	H3288_003_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	003	0	1	04	01	H3288_003_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	003	0	1	04	01	H3288_003_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	003	0	1	04	01	H3288_003_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	003	0	1	04	01	H3288_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	003	0	1	04	01	H3288_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	003	0	1	04	01	H3288_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											617.29	27						446.69	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	004	0	1	04	01	H3288_004_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	004	0	1	04	01	H3288_004_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	004	0	1	04	01	H3288_004_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	004	0	1	04	01	H3288_004_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	004	0	1	04	01	H3288_004_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	004	0	1	04	01	H3288_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	004	0	1	04	01	H3288_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											606.35	27						439.64	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	005	0	1	04	01	H3288_005_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	005	0	1	04	01	H3288_005_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	005	0	1	04	01	H3288_005_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	005	0	1	04	01	H3288_005_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	005	0	1	04	01	H3288_005_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	005	0	1	04	01	H3288_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	005	0	1	04	01	H3288_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											579.59	28						424.79	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	006	0	1	04	01	H3288_006_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	006	0	1	04	01	H3288_006_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	006	0	1	04	01	H3288_006_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	006	0	1	04	01	H3288_006_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	006	0	1	04	01	H3288_006_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	006	0	1	04	01	H3288_006_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	006	0	1	04	01	H3288_006_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											600.88	27						436.06	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	007	0	1	04	01	H3288_007_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	007	0	1	04	01	H3288_007_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	007	0	1	04	01	H3288_007_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	007	0	1	04	01	H3288_007_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	007	0	1	04	01	H3288_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	007	0	1	04	01	H3288_007_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	007	0	1	04	01	H3288_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											631.27	27						455.54	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	008	0	1	04	01	H3288_008_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	008	0	1	04	01	H3288_008_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	008	0	1	04	01	H3288_008_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	008	0	1	04	01	H3288_008_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	008	0	1	04	01	H3288_008_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	008	0	1	04	01	H3288_008_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	008	0	1	04	01	H3288_008_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											612.07	27						443.30	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	009	0	1	04	01	H3288_009_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	009	0	1	04	01	H3288_009_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	009	0	1	04	01	H3288_009_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	009	0	1	04	01	H3288_009_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	009	0	1	04	01	H3288_009_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	009	0	1	04	01	H3288_009_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	009	0	1	04	01	H3288_009_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											595.53	28						435.46	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	010	0	1	04	01	H3288_010_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	010	0	1	04	01	H3288_010_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	010	0	1	04	01	H3288_010_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	010	0	1	04	01	H3288_010_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	010	0	1	04	01	H3288_010_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	010	0	1	04	01	H3288_010_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	010	0	1	04	01	H3288_010_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											635.92	27						458.74	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	011	0	1	04	01	H3288_011_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	011	0	1	04	01	H3288_011_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	011	0	1	04	01	H3288_011_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	011	0	1	04	01	H3288_011_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	011	0	1	04	01	H3288_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	011	0	1	04	01	H3288_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	011	0	1	04	01	H3288_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											583.21	27						424.42	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	012	0	1	04	01	H3288_012_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	012	0	1	04	01	H3288_012_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	012	0	1	04	01	H3288_012_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	012	0	1	04	01	H3288_012_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	012	0	1	04	01	H3288_012_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	012	0	1	04	01	H3288_012_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	012	0	1	04	01	H3288_012_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											567.65	27						414.04	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	013	0	1	04	01	H3288_013_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	013	0	1	04	01	H3288_013_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	013	0	1	04	01	H3288_013_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	013	0	1	04	01	H3288_013_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	013	0	1	04	01	H3288_013_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	013	0	1	04	01	H3288_013_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	013	0	1	04	01	H3288_013_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											612.84	27						443.84	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	015	0	1	04	01	H3288_015_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	015	0	1	04	01	H3288_015_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	015	0	1	04	01	H3288_015_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	015	0	1	04	01	H3288_015_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	015	0	1	04	01	H3288_015_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	015	0	1	04	01	H3288_015_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	015	0	1	04	01	H3288_015_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											584.64	27						425.28	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	016	0	1	04	01	H3288_016_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	016	0	1	04	01	H3288_016_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	016	0	1	04	01	H3288_016_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	016	0	1	04	01	H3288_016_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	016	0	1	04	01	H3288_016_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	016	0	1	04	01	H3288_016_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	016	0	1	04	01	H3288_016_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											621.16	27						449.11	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	017	0	1	04	01	H3288_017_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	017	0	1	04	01	H3288_017_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	017	0	1	04	01	H3288_017_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	017	0	1	04	01	H3288_017_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	017	0	1	04	01	H3288_017_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	017	0	1	04	01	H3288_017_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	017	0	1	04	01	H3288_017_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											588.23	27						431.97	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	018	0	1	04	01	H3288_018_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	018	0	1	04	01	H3288_018_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	018	0	1	04	01	H3288_018_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	018	0	1	04	01	H3288_018_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	018	0	1	04	01	H3288_018_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	018	0	1	04	01	H3288_018_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	018	0	1	04	01	H3288_018_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											613.54	27						448.23	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	019	0	1	04	01	H3288_019_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	019	0	1	04	01	H3288_019_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	019	0	1	04	01	H3288_019_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	019	0	1	04	01	H3288_019_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	019	0	1	04	01	H3288_019_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	019	0	1	04	01	H3288_019_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	019	0	1	04	01	H3288_019_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											625.56	28						459.22	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	020	0	1	04	01	H3288_020_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	020	0	1	04	01	H3288_020_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	020	0	1	04	01	H3288_020_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	020	0	1	04	01	H3288_020_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	020	0	1	04	01	H3288_020_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	020	0	1	04	01	H3288_020_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	020	0	1	04	01	H3288_020_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											556.72	27						411.25	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	021	0	1	04	01	H3288_021_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	021	0	1	04	01	H3288_021_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	021	0	1	04	01	H3288_021_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	021	0	1	04	01	H3288_021_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	021	0	1	04	01	H3288_021_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	021	0	1	04	01	H3288_021_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	021	0	1	04	01	H3288_021_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											612.27	27						447.58	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	022	0	1	04	01	H3288_022_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	022	0	1	04	01	H3288_022_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	022	0	1	04	01	H3288_022_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	022	0	1	04	01	H3288_022_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	022	0	1	04	01	H3288_022_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	022	0	1	04	01	H3288_022_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	022	0	1	04	01	H3288_022_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											602.77	27						437.29	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	023	0	1	04	01	H3288_023_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	023	0	1	04	01	H3288_023_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	023	0	1	04	01	H3288_023_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	023	0	1	04	01	H3288_023_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	023	0	1	04	01	H3288_023_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	023	0	1	04	01	H3288_023_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	023	0	1	04	01	H3288_023_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											599.62	28						436.67	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	024	0	1	04	01	H3288_024_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	024	0	1	04	01	H3288_024_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	024	0	1	04	01	H3288_024_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	024	0	1	04	01	H3288_024_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	024	0	1	04	01	H3288_024_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	024	0	1	04	01	H3288_024_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	024	0	1	04	01	H3288_024_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											633.24	29						461.48	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	025	0	1	04	01	H3288_025_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	025	0	1	04	01	H3288_025_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	025	0	1	04	01	H3288_025_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	025	0	1	04	01	H3288_025_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	025	0	1	04	01	H3288_025_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	025	0	1	04	01	H3288_025_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	025	0	1	04	01	H3288_025_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											631.43	29						460.23	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	026	0	1	04	01	H3288_026_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	026	0	1	04	01	H3288_026_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	026	0	1	04	01	H3288_026_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	026	0	1	04	01	H3288_026_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	026	0	1	04	01	H3288_026_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	026	0	1	04	01	H3288_026_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	026	0	1	04	01	H3288_026_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											616.82	28						448.18	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	027	0	1	04	01	H3288_027_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	027	0	1	04	01	H3288_027_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	027	0	1	04	01	H3288_027_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	027	0	1	04	01	H3288_027_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	027	0	1	04	01	H3288_027_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	027	0	1	04	01	H3288_027_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	027	0	1	04	01	H3288_027_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											613.76	29						448.37	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	028	0	1	04	01	H3288_028_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	028	0	1	04	01	H3288_028_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	028	0	1	04	01	H3288_028_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	028	0	1	04	01	H3288_028_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	028	0	1	04	01	H3288_028_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	028	0	1	04	01	H3288_028_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	028	0	1	04	01	H3288_028_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											658.37	29						477.90	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	029	0	1	04	01	H3288_029_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	029	0	1	04	01	H3288_029_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	029	0	1	04	01	H3288_029_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	029	0	1	04	01	H3288_029_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	029	0	1	04	01	H3288_029_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	029	0	1	04	01	H3288_029_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	029	0	1	04	01	H3288_029_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											687.30	29						496.77	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	030	0	1	04	01	H3288_030_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	030	0	1	04	01	H3288_030_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	030	0	1	04	01	H3288_030_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	030	0	1	04	01	H3288_030_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	030	0	1	04	01	H3288_030_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	030	0	1	04	01	H3288_030_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	030	0	1	04	01	H3288_030_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											649.43	29						472.19	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	031	0	1	04	01	H3288_031_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	031	0	1	04	01	H3288_031_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	031	0	1	04	01	H3288_031_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	031	0	1	04	01	H3288_031_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	031	0	1	04	01	H3288_031_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	031	0	1	04	01	H3288_031_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	031	0	1	04	01	H3288_031_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											625.36	29						456.14	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	032	0	1	04	01	H3288_032_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	032	0	1	04	01	H3288_032_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	032	0	1	04	01	H3288_032_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	032	0	1	04	01	H3288_032_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	032	0	1	04	01	H3288_032_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	032	0	1	04	01	H3288_032_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	032	0	1	04	01	H3288_032_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											668.25	29						484.51	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	033	0	1	04	01	H3288_033_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	033	0	1	04	01	H3288_033_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	033	0	1	04	01	H3288_033_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	033	0	1	04	01	H3288_033_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	033	0	1	04	01	H3288_033_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	033	0	1	04	01	H3288_033_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	033	0	1	04	01	H3288_033_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											645.00	29						469.44	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	035	0	1	04	01	H3288_035_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	035	0	1	04	01	H3288_035_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	035	0	1	04	01	H3288_035_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	035	0	1	04	01	H3288_035_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	035	0	1	04	01	H3288_035_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	035	0	1	04	01	H3288_035_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	035	0	1	04	01	H3288_035_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											613.65	28						446.01	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	036	0	1	04	01	H3288_036_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	036	0	1	04	01	H3288_036_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	036	0	1	04	01	H3288_036_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	036	0	1	04	01	H3288_036_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	036	0	1	04	01	H3288_036_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	036	0	1	04	01	H3288_036_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	036	0	1	04	01	H3288_036_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											617.69	29						451.06	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	037	0	1	04	01	H3288_037_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	037	0	1	04	01	H3288_037_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	037	0	1	04	01	H3288_037_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	037	0	1	04	01	H3288_037_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	037	0	1	04	01	H3288_037_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	037	0	1	04	01	H3288_037_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	037	0	1	04	01	H3288_037_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											631.53	29						460.34	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	038	0	1	04	01	H3288_038_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	038	0	1	04	01	H3288_038_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	038	0	1	04	01	H3288_038_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	038	0	1	04	01	H3288_038_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	038	0	1	04	01	H3288_038_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	038	0	1	04	01	H3288_038_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	038	0	1	04	01	H3288_038_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											632.97	29						461.31	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	039	0	1	04	01	H3288_039_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	039	0	1	04	01	H3288_039_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	039	0	1	04	01	H3288_039_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	039	0	1	04	01	H3288_039_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	039	0	1	04	01	H3288_039_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	039	0	1	04	01	H3288_039_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	039	0	1	04	01	H3288_039_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											628.81	29						458.50	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	040	0	1	04	01	H3288_040_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	040	0	1	04	01	H3288_040_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	040	0	1	04	01	H3288_040_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	040	0	1	04	01	H3288_040_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	040	0	1	04	01	H3288_040_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	040	0	1	04	01	H3288_040_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	040	0	1	04	01	H3288_040_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											610.10	29						445.93	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	041	0	1	04	01	H3288_041_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	041	0	1	04	01	H3288_041_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	041	0	1	04	01	H3288_041_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	041	0	1	04	01	H3288_041_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	041	0	1	04	01	H3288_041_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	041	0	1	04	01	H3288_041_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	041	0	1	04	01	H3288_041_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											660.01	29						478.86	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	042	0	1	04	01	H3288_042_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	042	0	1	04	01	H3288_042_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	042	0	1	04	01	H3288_042_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	042	0	1	04	01	H3288_042_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	042	0	1	04	01	H3288_042_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	042	0	1	04	01	H3288_042_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	042	0	1	04	01	H3288_042_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											686.09	29						495.70	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	043	0	1	04	01	H3288_043_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	043	0	1	04	01	H3288_043_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	043	0	1	04	01	H3288_043_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	043	0	1	04	01	H3288_043_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	043	0	1	04	01	H3288_043_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	043	0	1	04	01	H3288_043_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	043	0	1	04	01	H3288_043_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											643.63	29						468.42	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	044	0	1	04	01	H3288_044_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	044	0	1	04	01	H3288_044_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	044	0	1	04	01	H3288_044_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	044	0	1	04	01	H3288_044_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	044	0	1	04	01	H3288_044_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	044	0	1	04	01	H3288_044_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	044	0	1	04	01	H3288_044_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											622.80	29						454.45	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	045	0	1	04	01	H3288_045_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00					9.00			9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	045	0	1	04	01	H3288_045_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	045	0	1	04	01	H3288_045_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00					47.00			47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	045	0	1	04	01	H3288_045_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					98.00	196.00	294.00											100.00	200.00	300.00				98.00	196.00	294.00					100.00			100.00			3.33	3.27		3.33	3.27	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	045	0	1	04	01	H3288_045_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											451.18	25						485.46	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	046	0	1	04	01	H3288_046_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	046	0	1	04	01	H3288_046_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	046	0	1	04	01	H3288_046_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	046	0	1	04	01	H3288_046_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	046	0	1	04	01	H3288_046_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	046	0	1	04	01	H3288_046_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	046	0	1	04	01	H3288_046_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											600.42	27						435.76	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	047	0	1	04	01	H3288_047_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	047	0	1	04	01	H3288_047_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	047	0	1	04	01	H3288_047_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	047	0	1	04	01	H3288_047_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	047	0	1	04	01	H3288_047_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	047	0	1	04	01	H3288_047_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	047	0	1	04	01	H3288_047_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											655.78	29						478.02	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	048	0	1	04	01	H3288_048_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	048	0	1	04	01	H3288_048_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	048	0	1	04	01	H3288_048_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	048	0	1	04	01	H3288_048_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3288	048	0	1	04	01	H3288_048_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	048	0	1	04	01	H3288_048_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3288	048	0	1	04	01	H3288_048_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											600.63	27						435.93	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3293	003	0	1	01	01	H3293_003_0	5		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	5		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	5		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	003	0	1	01	01	H3293_003_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1228.50	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	5		N	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	5		N	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H3293	004	0	1	01	01	H3293_004_0	5		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	5		N	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3293	004	0	1	01	01	H3293_004_0	5		N	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	25.00		75.00																					75.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	004	0	1	01	01	H3293_004_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				658.40	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	005	0	1	01	01	H3293_005_0	7		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	005	0	1	01	01	H3293_005_0	7		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H3293	005	0	1	01	01	H3293_005_0	7		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	005	0	1	01	01	H3293_005_0	7		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3293	005	0	1	01	01	H3293_005_0	7		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	005	0	1	01	01	H3293_005_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	15.00		45.00																					45.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3293	005	0	1	01	01	H3293_005_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				937.29	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3305	015	0	1	02	01	H3305_015_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				97.73	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				757.15	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3305	021	0	1	02	01	H3305_021_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				95.31	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	021	0	1	02	01	H3305_021_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				920.33	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	022	0	1	02	01	H3305_022_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	022	0	1	02	01	H3305_022_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3305	022	0	1	02	01	H3305_022_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	022	0	1	02	01	H3305_022_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	022	0	1	02	01	H3305_022_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				91.39	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	022	0	1	02	01	H3305_022_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1004.65	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	030	0	1	02	01	H3305_030_0	7		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	030	0	1	02	01	H3305_030_0	7		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	030	0	1	02	01	H3305_030_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	030	0	1	02	01	H3305_030_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				98.17	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	030	0	1	02	01	H3305_030_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				876.49	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	032	0	1	02	01	H3305_032_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	032	0	1	02	01	H3305_032_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	032	0	1	02	01	H3305_032_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	032	0	1	02	01	H3305_032_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				99.27	26		26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3305	032	0	1	02	01	H3305_032_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				883.64	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	002	0	1	01	01	H3307_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				252.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	012	0	1	01	01	H3307_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				246.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	015	0	1	01	01	H3307_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				349.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	023	0	1	01	01	H3307_023_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				204.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3307	025	0	1	01	01	H3307_025_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				297.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	002	0	1	01	01	H3312_002_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	002	0	1	01	01	H3312_002_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	002	0	1	01	01	H3312_002_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	002	0	1	01	01	H3312_002_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	002	0	1	01	01	H3312_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	002	0	1	01	01	H3312_002_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											701.57	28						353.71	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	018	0	1	01	01	H3312_018_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	018	0	1	01	01	H3312_018_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	018	0	1	01	01	H3312_018_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	018	0	1	01	01	H3312_018_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	018	0	1	01	01	H3312_018_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	018	0	1	01	01	H3312_018_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	018	0	1	01	01	H3312_018_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											715.53	28						512.95	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	048	0	1	01	01	H3312_048_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	048	0	1	01	01	H3312_048_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	048	0	1	01	01	H3312_048_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	048	0	1	01	01	H3312_048_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	048	0	1	01	01	H3312_048_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	048	0	1	01	01	H3312_048_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	048	0	1	01	01	H3312_048_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											712.27	33						518.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	062	0	1	01	01	H3312_062_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	062	0	1	01	01	H3312_062_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	062	0	1	01	01	H3312_062_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	062	0	1	01	01	H3312_062_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	062	0	1	01	01	H3312_062_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	062	0	1	01	01	H3312_062_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	062	0	1	01	01	H3312_062_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											711.22	28						516.75	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	064	0	1	01	01	H3312_064_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	064	0	1	01	01	H3312_064_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	064	0	1	01	01	H3312_064_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	064	0	1	01	01	H3312_064_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	064	0	1	01	01	H3312_064_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	064	0	1	01	01	H3312_064_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	064	0	1	01	01	H3312_064_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											673.99	29						471.47	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	065	0	1	01	01	H3312_065_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	065	0	1	01	01	H3312_065_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	065	0	1	01	01	H3312_065_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	065	0	1	01	01	H3312_065_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	065	0	1	01	01	H3312_065_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	065	0	1	01	01	H3312_065_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	065	0	1	01	01	H3312_065_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											687.25	28						497.74	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	068	0	1	01	01	H3312_068_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	068	0	1	01	01	H3312_068_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	068	0	1	01	01	H3312_068_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	068	0	1	01	01	H3312_068_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	068	0	1	01	01	H3312_068_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	068	0	1	01	01	H3312_068_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	068	0	1	01	01	H3312_068_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											708.44	27						506.48	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	069	0	1	01	01	H3312_069_0	3		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	069	0	1	01	01	H3312_069_0	3		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	069	0	1	01	01	H3312_069_0	3		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	069	0	1	01	01	H3312_069_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	069	0	1	01	01	H3312_069_0	3		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				481.70	29																				29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	070	0	1	01	01	H3312_070_0	3		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	070	0	1	01	01	H3312_070_0	3		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	070	0	1	01	01	H3312_070_0	3		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	070	0	1	01	01	H3312_070_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3312	070	0	1	01	01	H3312_070_0	3		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				492.22	29																				29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3330	021	1	1	01	01	H3330_021_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	7		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	7		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	7		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	038	0	1	01	01	H3330_038_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	038	0	1	01	01	H3330_038_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	038	0	1	01	01	H3330_038_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	038	0	1	01	01	H3330_038_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	038	0	1	01	01	H3330_038_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	9		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	1	1	01	01	H3330_039_1	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	9		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	039	2	1	01	01	H3330_039_2	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_0	9		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	040	0	1	01	01	H3330_040_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	9		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	1	1	02	01	H3330_041_1	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	9		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	041	2	1	02	01	H3330_041_2	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	4		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		26.00					8.00		16.00													26.00						16.00				13.00				8.00			0.43	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	4		Y	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	4		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		22.00					6.00		12.00													22.00						12.00				11.00				6.00			0.37	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	4		Y	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4		N	Preferred Generic	3	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								13.00		26.00					8.00		16.00													26.00						16.00				13.00				8.00			0.43	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4		N	Generic	3	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		40.00					15.00		30.00													40.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		90.00					40.00		80.00													90.00						80.00				45.00				40.00			1.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	4		N	Specialty Tier	3	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	25		25				1.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	4		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	4		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		26.00					8.00		16.00													26.00						16.00				13.00				8.00			0.43	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	4		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	4		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	4		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		30.00					10.00		20.00													30.00						20.00				15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	4		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	30		30				1.00	30		30												30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3342	023	1	1	04	01	H3342_023_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								43.00	86.00	129.00					38.00	76.00	114.00					38.00	114.00	114.00																43.00				43.00			1.43	1.27	1.27			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	1	1	04	01	H3342_023_1	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3342	023	2	1	04	01	H3342_023_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								43.00	86.00	129.00					38.00	76.00	114.00					38.00	114.00	114.00																43.00				43.00			1.43	1.27	1.27			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								93.00	186.00	279.00					88.00	176.00	264.00					88.00	264.00	264.00																93.00				93.00			3.10	2.93	2.93			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	023	2	1	04	01	H3342_023_2	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3344	005	0	1	04	01	H3344_005_0	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	9		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	9		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	9		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				66.64	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	16		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	16		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3344	010	0	1	04	01	H3344_010_0	16		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	16		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	45.00		112.50																					112.50																45.00				45.00		1.5						1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	16		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				47.45	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	010	0	1	04	01	H3344_010_0	16		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	009	0	1	01	01	H3347_009_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	009	0	1	01	01	H3347_009_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	009	0	1	01	01	H3347_009_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	009	0	1	01	01	H3347_009_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	009	0	1	01	01	H3347_009_0	4		N	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				813.97	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	14.00	28.00	42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				87.78	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	015	0	1	01	01	H3347_015_0	3		N	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				730.88	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	3		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		20.00					5.00		10.00													20.00						10.00				10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	3		Y	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	3		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		34.00					12.00		24.00													34.00						24.00				17.00				12.00			0.57	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	3		Y	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	3		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		30.00					10.00		20.00													30.00						20.00				15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	3		Y	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	3		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		40.00					15.00		30.00													40.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	3		Y	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	29		29				1.00	29		29												29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	3		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		30.00					10.00		20.00													30.00						20.00				15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	02	01	H3351_012_0	3		Y	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	3		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		40.00					15.00		30.00													40.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	02	01	H3351_013_0	3		Y	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	3		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		18.00					4.00		8.00													18.00						8.00				9.00				4.00			0.30	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	3		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		26.00					8.00		16.00													26.00						16.00				13.00				8.00			0.43	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		90.00					40.00		80.00													90.00						80.00				45.00				40.00			1.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	3		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	33		33				1.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	3		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	3		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		40.00					15.00		30.00													40.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	01	01	H3351_016_0	3		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	26		26				1.00	26		26												26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	3		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	3		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		38.00					14.00		28.00													38.00						28.00				19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	3		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	26		26				1.00	26		26												26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	3		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	3		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		40.00					15.00		30.00													40.00						30.00				20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	018	0	1	02	01	H3351_018_0	3		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	27		27				1.00	27		27												27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	3		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		10.00					0.00		0.00													10.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	3		N	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		38.00					14.00		28.00													38.00						28.00				19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		94.00					42.00		84.00													94.00						84.00				47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		200.00					95.00		190.00													200.00						190.00				100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	019	0	1	02	01	H3351_019_0	3		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1.00	30		30				1.00	30		30												30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	10.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	47.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	100.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	10.00		25.00																					25.00																10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	40.00		100.00																					100.00																40.00				40.00		1.33						1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				76.98	43		43																				43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	8		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	8		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.5						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	8		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		34				61.47	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				23.01	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	7		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.5						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	42.00		105.00																					105.00																42.00				42.00		1.4						1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				83.24	46		46																				46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	035	0	1	01	01	H3362_035_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	8		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				67.73	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	035	0	1	01	01	H3362_035_0	8		Y	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		34	11.00		27.50																					27.50																11.00				11.00		0.37						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3362	038	0	1	01	01	H3362_038_0	14		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	14		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	14		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	14		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		34				92.34	41		41																				41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	038	0	1	01	01	H3362_038_0	14		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					26																																					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	001	0	1	01	01	H3379_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				354.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	039	0	1	01	01	H3379_039_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				234.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	01	01	H3379_040_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	01	01	H3379_040_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	01	01	H3379_040_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	040	0	1	01	01	H3379_040_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	01	01	H3379_040_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	040	0	1	01	01	H3379_040_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				250.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3379	041	0	1	01	01	H3379_041_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	041	0	1	01	01	H3379_041_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				217.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		0.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												29		29					29		29				29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		39.00					8.00		24.00					8.00		20.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	01	01	H3384_059_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												28		28					28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	062	0	1	01	01	H3384_062_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	063	0	1	01	01	H3384_063_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	064	0	1	01	01	H3384_064_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								5.00		15.00					0.00		0.00					0.00		0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	064	0	1	01	01	H3384_064_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		30.00					5.00		15.00					5.00		12.50																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	064	0	1	01	01	H3384_064_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	064	0	1	01	01	H3384_064_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	064	0	1	01	01	H3384_064_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												31		31					31		31				31		31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	12		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	12		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	12		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	12		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		225.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	12		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1588.16	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	13		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	13		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		26.00				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	13		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.40				1.40	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	13		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	93.00		279.00																									93.00		279.00				93.00		232.50				93.00				93.00		3.10				3.10	3.10	3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	13		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1662.83	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		242.50				97.00				97.00		3.23				3.23	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	13		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1919.14	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	014	0	1	01	01	H3388_014_0	13		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	014	0	1	01	01	H3388_014_0	13		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		34.00				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	014	0	1	01	01	H3388_014_0	13		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	014	0	1	01	01	H3388_014_0	13		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	014	0	1	01	01	H3388_014_0	13		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1399.46	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3404	003	1	1	04	01	H3404_003_1	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.20		.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.23	50	50	50				73.03	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	1	1	04	01	H3404_003_1	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3404	003	2	1	04	01	H3404_003_2	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.20		.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.23	50	50	50				73.03	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3404	003	2	1	04	01	H3404_003_2	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3416	001	6	1	04	01	H3416_001_6	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	3		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	6	1	04	01	H3416_001_6	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	3		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	7	1	04	01	H3416_001_7	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	4	1	04	01	H3416_002_4	4		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	4		Y	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.13				0.13	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	4	1	04	01	H3416_002_4	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	4	1	04	01	H3416_002_4	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	5	1	04	01	H3416_002_5	4		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	4		Y	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.13				0.13	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	5	1	04	01	H3416_002_5	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		117.50				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	5	1	04	01	H3416_002_5	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3418	001	0	1	04	01	H3418_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3418	001	0	1	04	01	H3418_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				370.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2.00	4.00	6.00																																						2.00			2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	5		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3419	002	0	1	01	01	H3419_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				1034.75	25																																						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	3		Y	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3442	001	0	1	04	01	H3442_001_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3442	001	0	1	04	01	H3442_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	001	0	1	04	01	H3442_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											484.00	33						346.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	003	0	1	04	01	H3442_003_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	003	0	1	04	01	H3442_003_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	003	0	1	04	01	H3442_003_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3442	003	0	1	04	01	H3442_003_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	003	0	1	04	01	H3442_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	003	0	1	04	01	H3442_003_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											394.00	29						337.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3442	004	0	1	04	01	H3442_004_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	004	0	1	04	01	H3442_004_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											163.00	29						356.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	9.00		18.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3442	006	0	1	04	01	H3442_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	006	0	1	04	01	H3442_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				364.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3442	007	0	1	04	01	H3442_007_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3442	007	0	1	04	01	H3442_007_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											328.00	29						322.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3447	001	0	1	01	01	H3447_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	003	0	1	01	01	H3447_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			0.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.50	29.00	43.50					9.50	19.00	28.50					9.50	19.00	19.00																14.50				14.50			0.48	0.32	0.32			.43	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	004	0	1	01	01	H3447_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	005	0	1	01	01	H3447_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.50	35.00	52.50					12.50	25.00	37.50					12.50	25.00	25.00																17.50				17.50			0.58	0.42	0.42			0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	010	0	1	01	01	H3447_010_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	010	0	1	01	01	H3447_010_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	011	0	1	01	01	H3447_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	011	0	1	01	01	H3447_011_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	011	0	1	01	01	H3447_011_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	012	0	1	01	01	H3447_012_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	012	0	1	01	01	H3447_012_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	012	0	1	01	01	H3447_012_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	013	0	1	01	01	H3447_013_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	013	0	1	01	01	H3447_013_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	014	0	1	01	01	H3447_014_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	014	0	1	01	01	H3447_014_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	014	0	1	01	01	H3447_014_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	014	0	1	01	01	H3447_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	014	0	1	01	01	H3447_014_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	014	0	1	01	01	H3447_014_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	014	0	1	01	01	H3447_014_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	018	0	1	01	01	H3447_018_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	018	0	1	01	01	H3447_018_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	018	0	1	01	01	H3447_018_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	018	0	1	01	01	H3447_018_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	019	0	1	01	01	H3447_019_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	019	0	1	01	01	H3447_019_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	019	0	1	01	01	H3447_019_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	019	0	1	01	01	H3447_019_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	019	0	1	01	01	H3447_019_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	019	0	1	01	01	H3447_019_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	019	0	1	01	01	H3447_019_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	019	0	1	01	01	H3447_019_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	020	0	1	01	01	H3447_020_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	020	0	1	01	01	H3447_020_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	020	0	1	01	01	H3447_020_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	020	0	1	01	01	H3447_020_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	021	0	1	01	01	H3447_021_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	021	0	1	01	01	H3447_021_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	021	0	1	01	01	H3447_021_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	021	0	1	01	01	H3447_021_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	021	0	1	01	01	H3447_021_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	021	0	1	01	01	H3447_021_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	021	0	1	01	01	H3447_021_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	022	0	1	01	01	H3447_022_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	022	0	1	01	01	H3447_022_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	023	0	1	01	01	H3447_023_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	023	0	1	01	01	H3447_023_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	023	0	1	01	01	H3447_023_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	023	0	1	01	01	H3447_023_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	023	0	1	01	01	H3447_023_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	023	0	1	01	01	H3447_023_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	023	0	1	01	01	H3447_023_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	024	0	1	01	01	H3447_024_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	024	0	1	01	01	H3447_024_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00	27.00	27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	270.00	270.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	024	0	1	01	01	H3447_024_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	025	0	1	01	01	H3447_025_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	025	0	1	01	01	H3447_025_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	025	0	1	01	01	H3447_025_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	025	0	1	01	01	H3447_025_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	025	0	1	01	01	H3447_025_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	025	0	1	01	01	H3447_025_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	025	0	1	01	01	H3447_025_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	026	0	1	01	01	H3447_026_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	026	0	1	01	01	H3447_026_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	026	0	1	01	01	H3447_026_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	026	0	1	01	01	H3447_026_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3447	027	0	1	01	01	H3447_027_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	7		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3447	027	0	1	01	01	H3447_027_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00	48.00	48.00																16.00				16.00			0.53	0.53	0.53			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	027	0	1	01	01	H3447_027_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	028	0	1	01	01	H3447_028_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		1
H3447	028	0	1	01	01	H3447_028_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	30.00	30.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	028	0	1	01	01	H3447_028_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	030	0	1	01	01	H3447_030_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	030	0	1	01	01	H3447_030_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	030	0	1	01	01	H3447_030_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	030	0	1	01	01	H3447_030_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	031	0	1	01	01	H3447_031_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	031	0	1	01	01	H3447_031_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	031	0	1	01	01	H3447_031_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	031	0	1	01	01	H3447_031_0	8		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	031	0	1	01	01	H3447_031_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	031	0	1	01	01	H3447_031_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	031	0	1	01	01	H3447_031_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	031	0	1	01	01	H3447_031_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	031	0	1	01	01	H3447_031_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	1	1	01	01	H3449_023_1	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.25	43	43	43				94.14	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	1	1	01	01	H3449_023_1	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	2	1	01	01	H3449_023_2	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.25	43	43	43				94.14	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	2	1	01	01	H3449_023_2	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	4	1	01	01	H3449_023_4	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.25	43	43	43				94.14	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	4	1	01	01	H3449_023_4	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	023	5	1	01	01	H3449_023_5	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	01	01	H3449_023_5	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	01	01	H3449_023_5	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	01	01	H3449_023_5	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.25	43	43	43				94.14	41	41	41										43	43	43				41	41	41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	01	01	H3449_023_5	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	01	01	H3449_023_5	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	023	5	1	01	01	H3449_023_5	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	024	1	1	01	01	H3449_024_1	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.20		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.53	50	50	50				72.08	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	1	1	01	01	H3449_024_1	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	024	2	1	01	01	H3449_024_2	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.20		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.53	50	50	50				72.08	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	2	1	01	01	H3449_024_2	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	024	3	1	01	01	H3449_024_3	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	01	01	H3449_024_3	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.20		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	01	01	H3449_024_3	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	01	01	H3449_024_3	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.53	50	50	50				72.08	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	01	01	H3449_024_3	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	01	01	H3449_024_3	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	024	3	1	01	01	H3449_024_3	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								1.00	1.00	1.00					0.00	0.00	0.00											1.00	1.00	1.00				0.00	0.00	0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	025	0	1	01	01	H3449_025_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.10		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	025	0	1	01	01	H3449_025_0	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.33		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	025	0	1	01	01	H3449_025_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	025	0	1	01	01	H3449_025_0	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.53	38	38	38				94.76	36	36	36										38	38	38				36	36	36			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	025	0	1	01	01	H3449_025_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	025	0	1	01	01	H3449_025_0	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	025	0	1	01	01	H3449_025_0	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3449	026	0	1	01	01	H3449_026_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	8		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.20		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.24	50	50	50				70.54	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3449	026	0	1	01	01	H3449_026_0	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	3.00	3.00					0.00	0.00	0.00											3.00	3.00	3.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3464	001	0	1	01	01	H3464_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	01	01	H3464_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	01	01	H3464_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3464	001	0	1	01	01	H3464_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	01	01	H3464_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	001	0	1	01	01	H3464_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				275.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3464	002	0	1	01	01	H3464_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	002	0	1	01	01	H3464_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				447.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	003	0	1	01	01	H3464_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	003	0	1	01	01	H3464_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	003	0	1	01	01	H3464_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3464	003	0	1	01	01	H3464_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	003	0	1	01	01	H3464_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	003	0	1	01	01	H3464_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				463.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	004	0	1	01	01	H3464_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	004	0	1	01	01	H3464_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	004	0	1	01	01	H3464_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3464	004	0	1	01	01	H3464_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	004	0	1	01	01	H3464_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3464	004	0	1	01	01	H3464_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				327.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	11		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	11		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	11		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				71.38	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	11		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	9		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	9		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				46.80	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	9		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	11		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	11		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	11		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.16	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	11		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	10		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				55.97	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	10		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.59	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	11		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	11		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	11		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				59.80	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	11		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	10		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				55.70	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	10		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	11		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	11		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	11		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				58.61	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	017	0	1	01	01	H3471_017_0	11		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	11		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	11		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	11		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				98.54	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	018	0	1	02	01	H3471_018_0	11		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	002	0	1	01	01	H3499_002_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	002	0	1	01	01	H3499_002_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	005	0	1	01	01	H3499_005_0	3		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	005	0	1	01	01	H3499_005_0	3		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	005	0	1	01	01	H3499_005_0	3		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	005	0	1	01	01	H3499_005_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				95.00	49	49	49																		49	49	49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	005	0	1	01	01	H3499_005_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	007	0	1	01	01	H3499_007_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	007	0	1	01	01	H3499_007_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3499	008	0	1	01	01	H3499_008_0	3		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	008	0	1	01	01	H3499_008_0	3		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	008	0	1	01	01	H3499_008_0	3		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	008	0	1	01	01	H3499_008_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				78.00	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3499	008	0	1	01	01	H3499_008_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	006	0	1	02	01	H3528_006_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	8		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	006	0	1	02	01	H3528_006_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	1	1	02	01	H3528_011_1	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	1	1	02	01	H3528_011_1	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	1	1	02	01	H3528_011_1	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	1	1	02	01	H3528_011_1	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	1	1	02	01	H3528_011_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	2	1	02	01	H3528_011_2	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	2	1	02	01	H3528_011_2	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	2	1	02	01	H3528_011_2	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	2	1	02	01	H3528_011_2	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	011	2	1	02	01	H3528_011_2	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	014	0	1	01	01	H3528_014_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	015	0	1	02	01	H3528_015_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	015	0	1	02	01	H3528_015_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	015	0	1	02	01	H3528_015_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	015	0	1	02	01	H3528_015_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	015	0	1	02	01	H3528_015_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	016	0	1	01	01	H3528_016_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	016	0	1	01	01	H3528_016_0	9		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	016	0	1	01	01	H3528_016_0	9		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	016	0	1	01	01	H3528_016_0	9		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	016	0	1	01	01	H3528_016_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	016	0	1	01	01	H3528_016_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	016	0	1	01	01	H3528_016_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	017	0	1	01	01	H3528_017_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					2.00	4.00	6.00					0.00	0.00	0.00																9.00				9.00			0.30	0.07	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	017	0	1	01	01	H3528_017_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	25.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	017	0	1	01	01	H3528_017_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	017	0	1	01	01	H3528_017_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	017	0	1	01	01	H3528_017_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.07		0.13	0.07	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	027	0	1	01	01	H3533_027_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	031	0	1	01	01	H3533_031_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	031	0	1	01	01	H3533_031_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	031	0	1	01	01	H3533_031_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	031	0	1	01	01	H3533_031_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	031	0	1	01	01	H3533_031_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	1	1	01	01	H3533_032_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	032	2	1	01	01	H3533_032_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	033	0	1	01	01	H3533_033_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3536	002	0	1	01	01	H3536_002_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	002	0	1	01	01	H3536_002_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3536	004	0	1	01	01	H3536_004_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3536	004	0	1	01	01	H3536_004_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								39.00	78.00	117.00					39.00	78.00	117.00					39.00	117.00	117.00																39.00				39.00			1.30	1.30	1.30			1.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3536	005	0	1	01	01	H3536_005_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	005	0	1	01	01	H3536_005_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3554	001	0	1	04	01	H3554_001_0	9		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	001	0	1	04	01	H3554_001_0	9		N	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	001	0	1	04	01	H3554_001_0	9		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	001	0	1	04	01	H3554_001_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				88.88	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	001	0	1	04	01	H3554_001_0	9		N	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	26		26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	001	0	1	04	01	H3554_001_0	9		N	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	001	0	1	04	01	H3554_001_0	9		N	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	002	0	1	04	01	H3554_002_0	8		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	8		N	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				88.88	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	8		N	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	26		26																		26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	8		N	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	002	0	1	04	01	H3554_002_0	8		N	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	003	0	1	04	01	H3554_003_0	8		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	003	0	1	04	01	H3554_003_0	8		N	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	13.00		26.00																			13.00		0.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	003	0	1	04	01	H3554_003_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	003	0	1	04	01	H3554_003_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				82.67	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	003	0	1	04	01	H3554_003_0	8		N	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	28		28																		28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	003	0	1	04	01	H3554_003_0	8		N	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	003	0	1	04	01	H3554_003_0	8		N	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	004	0	1	04	01	H3554_004_0	8		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	4.00		8.00																			4.00		0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	8		N	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	13.00		26.00																			13.00		0.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				82.68	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	8		N	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	28		28																		28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	8		N	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	004	0	1	04	01	H3554_004_0	8		N	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	005	0	1	04	01	H3554_005_0	8		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	4.00		8.00																			4.00		0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	005	0	1	04	01	H3554_005_0	8		N	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	13.00		26.00																			13.00		0.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	005	0	1	04	01	H3554_005_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	005	0	1	04	01	H3554_005_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				82.68	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	005	0	1	04	01	H3554_005_0	8		N	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	28		28																		28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	005	0	1	04	01	H3554_005_0	8		N	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	005	0	1	04	01	H3554_005_0	8		N	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	006	0	1	04	01	H3554_006_0	8		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	4.00		8.00																			4.00		0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	006	0	1	04	01	H3554_006_0	8		N	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	13.00		26.00																			13.00		0.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	006	0	1	04	01	H3554_006_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	006	0	1	04	01	H3554_006_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				82.68	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	006	0	1	04	01	H3554_006_0	8		N	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	28		28																		28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	006	0	1	04	01	H3554_006_0	8		N	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	006	0	1	04	01	H3554_006_0	8		N	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	007	0	1	04	01	H3554_007_0	10		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	10		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3554	007	0	1	04	01	H3554_007_0	10		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	10		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	10		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	007	0	1	04	01	H3554_007_0	10		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	008	0	1	04	01	H3554_008_0	10		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	008	0	1	04	01	H3554_008_0	10		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	008	0	1	04	01	H3554_008_0	10		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	008	0	1	04	01	H3554_008_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	008	0	1	04	01	H3554_008_0	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	008	0	1	04	01	H3554_008_0	10		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	008	0	1	04	01	H3554_008_0	10		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	009	0	1	04	01	H3554_009_0	10		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	009	0	1	04	01	H3554_009_0	10		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	009	0	1	04	01	H3554_009_0	10		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	009	0	1	04	01	H3554_009_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	009	0	1	04	01	H3554_009_0	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	009	0	1	04	01	H3554_009_0	10		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	009	0	1	04	01	H3554_009_0	10		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3554	010	0	1	04	01	H3554_010_0	11		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	010	0	1	04	01	H3554_010_0	11		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	010	0	1	04	01	H3554_010_0	11		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	010	0	1	04	01	H3554_010_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	010	0	1	04	01	H3554_010_0	11		Y	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	010	0	1	04	01	H3554_010_0	11		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3554	010	0	1	04	01	H3554_010_0	11		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3557	001	0	1	04	01	H3557_001_0	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	101		1	30	60	90				1	2		60	90				30		31	0.00	0.00	0.00																				0.00	0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3557	001	0	1	04	01	H3557_001_0	11		Y	Preferred Generic	4	01	1	2	1	3	111		01	101		1	30	60	90				1	2		60	90				30		31	0.00	0.00	0.00																				0.00	0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3557	001	0	1	04	01	H3557_001_0	11		Y	Generic	4	01	1	2	2	1	111		01	101		1	30	60	90				1	2		60	90				30		31	0.00	0.00	0.00																				0.00	0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3557	001	0	1	04	01	H3557_001_0	11		Y	Generic	4	01	1	2	2	3	111		01	101		1	30	60	90				1	2		60	90				30		31	0.00	0.00	0.00																				0.00	0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3557	001	0	1	04	01	H3557_001_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	101		1	30	60	90				1	2		60	90				30		31	47.00	94.00	141.00																				94.00	117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3557	001	0	1	04	01	H3557_001_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	101		1	30	60	90				1	2		60	90				30		31	100.00	200.00	300.00																				200.00	250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3557	001	0	1	04	01	H3557_001_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	001	0	1	01	01	H3561_001_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	001	0	1	01	01	H3561_001_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	001	0	1	01	01	H3561_001_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	001	0	1	01	01	H3561_001_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				97.00	49	49	49																		49	49	49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	001	0	1	01	01	H3561_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	002	0	1	01	01	H3561_002_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	002	0	1	01	01	H3561_002_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	002	0	1	01	01	H3561_002_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	002	0	1	01	01	H3561_002_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				92.00	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	002	0	1	01	01	H3561_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	004	0	1	01	01	H3561_004_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	004	0	1	01	01	H3561_004_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	004	0	1	01	01	H3561_004_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	004	0	1	01	01	H3561_004_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				95.00	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	004	0	1	01	01	H3561_004_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	005	0	1	01	01	H3561_005_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	005	0	1	01	01	H3561_005_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	005	0	1	01	01	H3561_005_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	005	0	1	01	01	H3561_005_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				94.00	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	005	0	1	01	01	H3561_005_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	006	0	1	01	01	H3561_006_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	006	0	1	01	01	H3561_006_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	006	0	1	01	01	H3561_006_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	006	0	1	01	01	H3561_006_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				93.00	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3561	006	0	1	01	01	H3561_006_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3572	001	0	1	01	01	H3572_001_0	4		N	Generic	4	01	1	1	1	1	110		01			1	30		90				1	2							30		34				9.07	15		15																																			15			15								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3572	001	0	1	01	01	H3572_001_0	4		N	Preferred Brand	4	11	1	1	2	1	110		01			1	30		90				1	2							30		34				14.70	15		15																																			15			15								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3572	001	0	1	01	01	H3572_001_0	4		N	Non-Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				1	1							30		34				109.53	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3572	001	0	1	01	01	H3572_001_0	4		N	Specialty Tier	4	10	1	1	4	1	110		01			1	30		90				1	1							30		34				717.95	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3572	001	0	1	01	01	H3572_001_0	4		N	Select Care Drugs	4	01	1	1	5	1	110		01			1	30		90				1	2							30		34				0.00	0		0																																			0			0								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3572	001	0	1	01	01	H3572_001_0	4		N	Select Care Drugs	4	01	1	1	5	3	110		01			1	30		90				1	2							30		34				0.00	0		0																																			0			0								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3597	001	0	1	01	01	H3597_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	001	0	1	01	01	H3597_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	001	0	1	01	01	H3597_001_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	001	0	1	01	01	H3597_001_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	001	0	1	01	01	H3597_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	001	0	1	01	01	H3597_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	001	0	1	01	01	H3597_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											958.09	33						519.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	007	0	1	01	01	H3597_007_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	007	0	1	01	01	H3597_007_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	007	0	1	01	01	H3597_007_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	007	0	1	01	01	H3597_007_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	007	0	1	01	01	H3597_007_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	007	0	1	01	01	H3597_007_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	007	0	1	01	01	H3597_007_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											775.50	33						509.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	009	0	1	01	01	H3597_009_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	009	0	1	01	01	H3597_009_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	009	0	1	01	01	H3597_009_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	21.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	009	0	1	01	01	H3597_009_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	21.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	009	0	1	01	01	H3597_009_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	009	0	1	01	01	H3597_009_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	009	0	1	01	01	H3597_009_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											774.50	30						576.43	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	011	0	1	02	01	H3597_011_0	5		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	011	0	1	02	01	H3597_011_0	5		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	011	0	1	02	01	H3597_011_0	5		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	011	0	1	02	01	H3597_011_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3597	011	0	1	02	01	H3597_011_0	5		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				525.89	29																				29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3632	001	0	1	04	01	H3632_001_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3632	001	0	1	04	01	H3632_001_0	3		Y	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					14.00		42.00							0.00																20.00				14.00			0.67	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3632	001	0	1	04	01	H3632_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3632	001	0	1	04	01	H3632_001_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											46.50	50		50				47.72	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3632	001	0	1	04	01	H3632_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	004	0	1	01	01	H3653_004_0	5		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.5			0.5			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				696.88	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	015	0	1	01	01	H3653_015_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1041.77	32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	022	0	1	01	01	H3653_022_0	5		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	022	0	1	01	01	H3653_022_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1069.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	023	0	1	01	01	H3653_023_0	5		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	023	0	1	01	01	H3653_023_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				912.98	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	5		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	5		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3653	024	0	1	01	01	H3653_024_0	5		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	024	0	1	01	01	H3653_024_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				912.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3655	032	0	1	01	01	H3655_032_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	033	0	1	01	01	H3655_033_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	033	0	1	01	01	H3655_033_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	033	0	1	01	01	H3655_033_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	034	0	1	01	01	H3655_034_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	038	0	1	01	01	H3655_038_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	24.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	038	0	1	01	01	H3655_038_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	040	0	1	01	01	H3655_040_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	040	0	1	01	01	H3655_040_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	040	0	1	01	01	H3655_040_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	040	0	1	01	01	H3655_040_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	040	0	1	01	01	H3655_040_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	040	0	1	01	01	H3655_040_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	040	0	1	01	01	H3655_040_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	041	0	1	01	01	H3655_041_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	041	0	1	01	01	H3655_041_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	041	0	1	01	01	H3655_041_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	042	0	1	01	01	H3655_042_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	042	0	1	01	01	H3655_042_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3660	028	0	1	02	01	H3660_028_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	028	0	1	02	01	H3660_028_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	6		N	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	39.00		97.50																					95.70																39.00				39.00		1.30						1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	6		N	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	6		N	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	029	0	1	02	01	H3660_029_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	029	0	1	02	01	H3660_029_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	6		N	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	44.00		110.00																					110.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	6		N	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	6		N	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	044	0	1	01	01	H3660_044_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	044	0	1	01	01	H3660_044_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	6		N	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	44.00		110.00																					110.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	6		N	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	6		N	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	047	0	1	01	01	H3660_047_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		5.00																					5.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	2.00		5.00																					5.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	047	0	1	01	01	H3660_047_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	6		N	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	6		N	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	6		N	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	048	0	1	02	01	H3660_048_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	048	0	1	02	01	H3660_048_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		25.00																			10.00		25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	6		N	Preferred Brand	4	10	3	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		117.50																			47.00		117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	6		N	Vaccines	4	11	1	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	6		N	Vaccines	4	11	1	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	050	0	1	01	01	H3660_050_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	050	0	1	01	01	H3660_050_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	6		N	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	6		N	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	6		N	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	053	1	1	01	01	H3660_053_1	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	053	1	1	01	01	H3660_053_1	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	6		N	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	44.00		110.00																					110.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	6		N	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	1	1	01	01	H3660_053_1	6		N	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	053	2	1	01	01	H3660_053_2	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	6		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	053	2	1	01	01	H3660_053_2	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	6		N	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	44.00		110.00																					110.00																44.00				44.00		1.47						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	6		N	Vaccines	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	053	2	1	01	01	H3660_053_2	6		N	Vaccines	4	11	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3664	017	0	1	02	01	H3664_017_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					6.00	12.00	18.00					6.00	12.00	15.00																16.00				6.00			0.53	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					45.00	90.00	125.00																47.00				42.00			1.57	1.40	1.50			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											819.20	31						819.20	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					8.00	16.00	24.00					8.00	16.00	20.00																18.00				8.00			0.60	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					45.00	90.00	125.00																47.00				42.00			1.57	1.40	1.50			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	275.00																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											812.69	30						812.69	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	45.00																20.00				15.00			0.67	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					45.00	90.00	125.00																47.00				42.00			1.57	1.40	1.50			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											704.31	29						704.31	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	014	0	1	01	01	H3668_014_0	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	015	0	1	01	01	H3668_015_0	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.6			0.6			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	016	0	1	01	01	H3668_016_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	017	0	1	01	01	H3668_017_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	1	1	01	01	H3668_018_1	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	1	1	01	01	H3668_018_1	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	2	1	01	01	H3668_018_2	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	2	1	01	01	H3668_018_2	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	018	3	1	01	01	H3668_018_3	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	018	3	1	01	01	H3668_018_3	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	019	1	1	01	01	H3668_019_1	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	1	1	01	01	H3668_019_1	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	019	2	1	01	01	H3668_019_2	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	2	1	01	01	H3668_019_2	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	3	1	01	01	H3668_019_3	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	3	1	01	01	H3668_019_3	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	019	3	1	01	01	H3668_019_3	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	3	1	01	01	H3668_019_3	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	3	1	01	01	H3668_019_3	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	019	3	1	01	01	H3668_019_3	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	020	0	1	01	01	H3668_020_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.5			2.5			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	020	0	1	01	01	H3668_020_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	021	0	1	01	01	H3668_021_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	021	0	1	01	01	H3668_021_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	021	0	1	01	01	H3668_021_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	021	0	1	01	01	H3668_021_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	021	0	1	01	01	H3668_021_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	021	0	1	01	01	H3668_021_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	022	0	1	01	01	H3668_022_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	022	0	1	01	01	H3668_022_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	023	0	1	01	01	H3668_023_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	023	0	1	01	01	H3668_023_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	024	0	1	01	01	H3668_024_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	024	0	1	01	01	H3668_024_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	024	0	1	01	01	H3668_024_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			0.00	0.00	0.00																10.00				10.00		0.33			0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	024	0	1	01	01	H3668_024_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	024	0	1	01	01	H3668_024_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	024	0	1	01	01	H3668_024_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	025	0	1	01	01	H3668_025_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	025	0	1	01	01	H3668_025_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	026	0	1	01	01	H3668_026_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	026	0	1	01	01	H3668_026_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	027	0	1	01	01	H3668_027_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	027	0	1	01	01	H3668_027_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	027	0	1	01	01	H3668_027_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	027	0	1	01	01	H3668_027_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	027	0	1	01	01	H3668_027_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	027	0	1	01	01	H3668_027_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	028	0	1	01	01	H3668_028_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	028	0	1	01	01	H3668_028_0	5		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	028	0	1	01	01	H3668_028_0	5		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	028	0	1	01	01	H3668_028_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	028	0	1	01	01	H3668_028_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	028	0	1	01	01	H3668_028_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							0.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								47.00		141.00					47.00		141.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		300.00					100.00		300.00							200.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							0.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								47.00		141.00					47.00		141.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		300.00					100.00		300.00							200.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							0.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								47.00		141.00					47.00		141.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		300.00					100.00		300.00							200.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	025	0	1	01	01	H3672_025_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	025	0	1	01	01	H3672_025_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							0.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	025	0	1	01	01	H3672_025_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								47.00		141.00					47.00		141.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	025	0	1	01	01	H3672_025_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		300.00					100.00		300.00							200.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	025	0	1	01	01	H3672_025_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		0.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	5		N	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		0.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3706	001	0	1	01	01	H3706_001_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	1				30		90	30		31								20.00		60.00					15.00		0.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	1				30		90	30		31								47.00		141.00					42.00		84.00											47.00		141.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	5		N	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	1	1				30		90	30		31								47.00		141.00					42.00		84.00											47.00		141.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3706	001	0	1	01	01	H3706_001_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	1				30		90	30		31											59.23	50		50				46.34	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	6		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		31								8.00		24.00					3.00		0.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	6		N	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	1				30		90	30		31								8.00		24.00					3.00		0.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3706	018	0	1	01	01	H3706_018_0	6		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	1				30		90	30		31								18.00		54.00					13.00		0.00											18.00		54.00				13.00		0.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	1				30		90	30		31								45.00		135.00					40.00		80.00											45.00		135.00				40.00		80.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	6		N	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	1	1				30		90	30		31								45.00		135.00					40.00		80.00											45.00		135.00				40.00		80.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3706	018	0	1	01	01	H3706_018_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	1				30		90	30		31											80.72	50		50				64.22	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	021	0	1	02	01	H3706_021_0	6		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		0.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	021	0	1	02	01	H3706_021_0	6		N	Preferred Generic	4	11	1	2	1	3		110	01		110	1				30		90	1	1				30		90	30		31								10.00		30.00					5.00		0.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3706	021	0	1	02	01	H3706_021_0	6		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	1				30		90	30		31								20.00		60.00					15.00		0.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	021	0	1	02	01	H3706_021_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	1				30		90	30		31								47.00		141.00					42.00		84.00											47.00		141.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	021	0	1	02	01	H3706_021_0	6		N	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	1	1				30		90	30		31								47.00		141.00					42.00		84.00											47.00		141.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3706	021	0	1	02	01	H3706_021_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	1				30		90	30		31											59.23	50		50				46.34	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	021	0	1	02	01	H3706_021_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3725	001	0	1	04	01	H3725_001_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	001	0	1	04	01	H3725_001_0	5		N	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								16.00		32.00					8.00		16.00					8.00		16.00																16.00				16.00			0.53	0.27	0.27			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	001	0	1	04	01	H3725_001_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					39.00		78.00					39.00		78.00																47.00				47.00			1.57	1.3	1.3			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	001	0	1	04	01	H3725_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					92.00		184.00					92.00		184.00																100.00				100.00			3.33	3.07	3.07			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	001	0	1	04	01	H3725_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											734.83	33						734.83	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	001	0	1	04	01	H3725_001_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	001	0	1	04	01	H3725_001_0	5		N	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3725	004	0	1	04	01	H3725_004_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	004	0	1	04	01	H3725_004_0	4		N	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								16.00		32.00					8.00		16.00					8.00		16.00																16.00				16.00			0.53	0.27	0.27			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	004	0	1	04	01	H3725_004_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					39.00		78.00					39.00		78.00																47.00				47.00			1.57	1.3	1.3			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	004	0	1	04	01	H3725_004_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					92.00		184.00					92.00		184.00																100.00				100.00			3.33	3.07	3.07			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	004	0	1	04	01	H3725_004_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											601.19	25						601.19	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	004	0	1	04	01	H3725_004_0	4		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3725	004	0	1	04	01	H3725_004_0	4		N	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3727	001	1	1	01	01	H3727_001_1	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	11		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			15.00	30.00	45.00																17.00				17.00		0.57			0.50			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	11		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			40.00	80.00	120.00																45.00				45.00		1.50			1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	11		Y	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			90.00	180.00	270.00																92.00				92.00		3.07			3.00			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	1	1	01	01	H3727_001_1	11		Y	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				175.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	11		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	11		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			15.00	30.00	45.00																17.00				17.00		0.57			0.50			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	11		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			40.00	80.00	120.00																45.00				45.00		1.50			1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	11		Y	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			90.00	180.00	270.00																92.00				92.00		3.07			3.00			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	2	1	01	01	H3727_001_2	11		Y	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				175.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			5.00	10.00	15.00																6.00				6.00		0.20			0.17			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	51.00																			15.00	30.00	45.00																17.00				17.00		0.57			0.50			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	10		Y	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			40.00	80.00	120.00																45.00				45.00		1.50			1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	10		Y	Non-Preferred Drug	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			90.00	180.00	270.00																92.00				92.00		3.07			3.00			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3727	001	3	1	01	01	H3727_001_3	10		Y	Specialty Tier	4	10	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				175.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3748	001	0	1	01	01	H3748_001_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	001	0	1	01	01	H3748_001_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	001	0	1	01	01	H3748_001_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	001	0	1	01	01	H3748_001_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	001	0	1	01	01	H3748_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	001	0	1	01	01	H3748_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	001	0	1	01	01	H3748_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											810.04	33						586.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	003	0	1	01	01	H3748_003_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	003	0	1	01	01	H3748_003_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	003	0	1	01	01	H3748_003_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	003	0	1	01	01	H3748_003_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	003	0	1	01	01	H3748_003_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	003	0	1	01	01	H3748_003_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	003	0	1	01	01	H3748_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											791.90	33						574.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	004	0	1	01	01	H3748_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	004	0	1	01	01	H3748_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	004	0	1	01	01	H3748_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	004	0	1	01	01	H3748_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	004	0	1	01	01	H3748_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	004	0	1	01	01	H3748_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	004	0	1	01	01	H3748_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											794.89	33						576.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	005	0	1	01	01	H3748_005_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	005	0	1	01	01	H3748_005_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	005	0	1	01	01	H3748_005_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	005	0	1	01	01	H3748_005_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	005	0	1	01	01	H3748_005_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	005	0	1	01	01	H3748_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	005	0	1	01	01	H3748_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											777.50	33						564.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	006	0	1	01	01	H3748_006_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	006	0	1	01	01	H3748_006_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	006	0	1	01	01	H3748_006_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	006	0	1	01	01	H3748_006_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	006	0	1	01	01	H3748_006_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	006	0	1	01	01	H3748_006_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	006	0	1	01	01	H3748_006_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											779.87	33						565.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	007	0	1	01	01	H3748_007_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	007	0	1	01	01	H3748_007_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	007	0	1	01	01	H3748_007_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	007	0	1	01	01	H3748_007_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	007	0	1	01	01	H3748_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	007	0	1	01	01	H3748_007_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	007	0	1	01	01	H3748_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											790.34	33						573.20	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	008	0	1	01	01	H3748_008_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	008	0	1	01	01	H3748_008_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	008	0	1	01	01	H3748_008_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	008	0	1	01	01	H3748_008_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	008	0	1	01	01	H3748_008_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	008	0	1	01	01	H3748_008_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	008	0	1	01	01	H3748_008_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											778.81	33						565.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	009	0	1	01	01	H3748_009_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	009	0	1	01	01	H3748_009_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	009	0	1	01	01	H3748_009_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	009	0	1	01	01	H3748_009_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3748	009	0	1	01	01	H3748_009_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	009	0	1	01	01	H3748_009_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3748	009	0	1	01	01	H3748_009_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											795.43	33						576.72	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3749	001	0	1	02	01	H3749_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	02	01	H3749_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	02	01	H3749_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3749	001	0	1	02	01	H3749_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	02	01	H3749_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	02	01	H3749_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				188.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3749	017	0	1	02	01	H3749_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	02	01	H3749_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				405.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3749	018	0	1	02	01	H3749_018_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	02	01	H3749_018_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				279.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	020	0	1	02	01	H3749_020_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	020	0	1	02	01	H3749_020_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	020	0	1	02	01	H3749_020_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3749	020	0	1	02	01	H3749_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	020	0	1	02	01	H3749_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	020	0	1	02	01	H3749_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				382.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	001	0	1	01	01	H3755_001_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	001	0	1	01	01	H3755_001_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	5		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1414.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	004	0	1	01	01	H3755_004_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		.40			.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	004	0	1	01	01	H3755_004_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	5		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1254.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	5		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	005	0	1	01	01	H3755_005_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			13.00	13.00	13.00																13.00				13.00		.43			.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			13.00	13.00	13.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3755	005	0	1	01	01	H3755_005_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	5		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1260.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3777	001	2	1	01	01	H3777_001_2	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	8		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	247.50																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	8		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	8		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	2	1	01	01	H3777_001_2	8		Y	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3777	001	3	1	01	01	H3777_001_3	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	8		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	247.50																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	8		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	8		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	3	1	01	01	H3777_001_3	8		Y	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3777	001	4	1	01	01	H3777_001_4	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	8		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	247.50																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	8		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				918.72	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	8		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3777	001	4	1	01	01	H3777_001_4	8		Y	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3805	001	0	1	01	01	H3805_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	001	0	1	01	01	H3805_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				163.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	007	0	1	01	01	H3805_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				508.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	015	0	1	01	01	H3805_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	016	0	1	01	01	H3805_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	017	0	1	01	01	H3805_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				362.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	019	0	1	01	01	H3805_019_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				289.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	020	0	1	01	01	H3805_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				103.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	021	0	1	01	01	H3805_021_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	021	0	1	01	01	H3805_021_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	021	0	1	01	01	H3805_021_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	021	0	1	01	01	H3805_021_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	021	0	1	01	01	H3805_021_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	021	0	1	01	01	H3805_021_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				249.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	1	1	01	01	H3805_023_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	1	1	01	01	H3805_023_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						24.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	1	1	01	01	H3805_023_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						24.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	023	1	1	01	01	H3805_023_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	1	1	01	01	H3805_023_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	1	1	01	01	H3805_023_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				237.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	2	1	01	01	H3805_023_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	2	1	01	01	H3805_023_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						24.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	2	1	01	01	H3805_023_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						24.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	023	2	1	01	01	H3805_023_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	2	1	01	01	H3805_023_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	023	2	1	01	01	H3805_023_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				237.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	1	1	01	01	H3805_025_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	1	1	01	01	H3805_025_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	1	1	01	01	H3805_025_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	025	1	1	01	01	H3805_025_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	1	1	01	01	H3805_025_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	1	1	01	01	H3805_025_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				417.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	2	1	01	01	H3805_025_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	2	1	01	01	H3805_025_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	2	1	01	01	H3805_025_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	025	2	1	01	01	H3805_025_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	2	1	01	01	H3805_025_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	025	2	1	01	01	H3805_025_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				417.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	029	0	1	01	01	H3805_029_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	029	0	1	01	01	H3805_029_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	029	0	1	01	01	H3805_029_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	029	0	1	01	01	H3805_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	029	0	1	01	01	H3805_029_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	029	0	1	01	01	H3805_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				412.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	030	0	1	01	01	H3805_030_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	030	0	1	01	01	H3805_030_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	030	0	1	01	01	H3805_030_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	030	0	1	01	01	H3805_030_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	030	0	1	01	01	H3805_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	030	0	1	01	01	H3805_030_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											329.00	30						277.00	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					0.00		0.00													60.00						0.00				20.00				20.00			0.66	0.00				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	032	0	1	02	01	H3805_032_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	032	0	1	02	01	H3805_032_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											437.00	33						202.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	033	0	1	02	01	H3805_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	033	0	1	02	01	H3805_033_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				240.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	034	0	1	02	01	H3805_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	034	0	1	02	01	H3805_034_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				403.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	01	01	H3805_036_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	01	01	H3805_036_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						24.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	01	01	H3805_036_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						24.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	036	0	1	01	01	H3805_036_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	01	01	H3805_036_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	036	0	1	01	01	H3805_036_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				313.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	01	01	H3805_037_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	01	01	H3805_037_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	01	01	H3805_037_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H3805	037	0	1	01	01	H3805_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	01	01	H3805_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	037	0	1	01	01	H3805_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				242.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	9		N	Preferred Generic	4	01	3	2	1	1	111		01		100	1	30	60	90				1	2						90	30		31	5.00	10.00	0.00																											15.00						0.00				5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	9		N	Preferred Generic	4	01	3	2	1	3	111		01		100	1	30	60	90				1	2						90	30		31	10.00	20.00	0.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H3810	003	0	1	01	01	H3810_003_0	9		N	Generic	4	01	1	2	2	1	111		01		100	1	30	60	90				1	2						90	30		31	15.00	30.00	30.00																											45.00						30.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01		100	1	30	60	90				1	2						90	30		31	47.00	94.00	94.00																											141.00						94.00				47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	9		N	Non-Preferred Brand	4	10	1	2	4	1	111		01		100	1	30	60	90				1	2						90	30		31	98.00	196.00	196.00																											294.00						196.00				98.00				98.00		3.27						3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01		100	1	30	60	90				1	2						90	30		31				0.00	29	29	29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	9		N	Select Care Drugs	4	11	1	2	6	1	111		01		100	1	30	60	90				1	2						90	30		31	0.00	0.00	0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	003	0	1	01	01	H3810_003_0	9		N	Select Care Drugs	4	11	1	2	6	3	111		01		100	1	30	60	90				1	2						90	30		31	0.00	0.00	0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3810	022	0	1	01	01	H3810_022_0	9		N	Preferred Generic	4	01	3	2	1	1	111		01		100	1	30	60	90				1	2						90	30		31	5.00	10.00	0.00																											15.00						0.00				5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	022	0	1	01	01	H3810_022_0	9		N	Preferred Generic	4	01	3	2	1	3	111		01		100	1	30	60	90				1	2						90	30		31	10.00	20.00	0.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H3810	022	0	1	01	01	H3810_022_0	9		N	Generic	4	01	1	2	2	1	111		01		100	1	30	60	90				1	2						90	30		31	15.00	30.00	45.00																											45.00						45.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	022	0	1	01	01	H3810_022_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01		100	1	30	60	90				1	2						90	30		31	47.00	94.00	141.00																											141.00						141.00				47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	022	0	1	01	01	H3810_022_0	9		N	Non-Preferred Brand	4	10	1	2	4	1	111		01		100	1	30	60	90				1	2						90	30		31	100.00	200.00	300.00																											300.00						300.00				100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	022	0	1	01	01	H3810_022_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01		100	1	30	60	90				1	2						90	30		31				0.00	27	27	27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	022	0	1	01	01	H3810_022_0	9		N	Select Care Drugs	4	11	1	2	6	1	111		01		100	1	30	60	90				1	2						90	30		31	0.00	0.00	0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3810	022	0	1	01	01	H3810_022_0	9		N	Select Care Drugs	4	11	1	2	6	3	111		01		100	1	30	60	90				1	2						90	30		31	0.00	0.00	0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3811	002	0	1	01	01	H3811_002_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	34	60	90				1	2			90				34		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.38						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	34	60	90				1	2			90				34		31	100.00	200.00	300.00																					300.00																100.00				100.00		2.94						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		31				1272.07	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	002	0	1	01	01	H3811_002_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	34	60	90				1	2			90				34		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3811	009	0	1	01	01	H3811_009_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	4		N	Generic	4	11	1	2	2	3	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3811	009	0	1	01	01	H3811_009_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	34	60	90				1	2			90				34		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.38						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	34	60	90				1	2			90				34		31	100.00	200.00	300.00																					300.00																100.00				100.00		2.94						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	34														34		31				1294.84	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	34	60	90				1	2			90				34		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3811	009	0	1	01	01	H3811_009_0	4		N	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	34	60	90				1	2			90				34		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3813	009	0	1	04	01	H3813_009_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	8		N	Generic	4	01	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	8		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				500.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	009	0	1	04	01	H3813_009_0	8		N	Vaccines	4	10	1	2	6	1	010		01	010		1	31								31						31		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				500.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	010	0	1	04	01	H3813_010_0	7		N	Vaccines	4	10	1	2	6	1	010		01	010		1	30								30						30		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				500.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	011	0	1	04	01	H3813_011_0	7		N	Vaccines	4	10	1	2	6	1	010		01	010		1	30								30						30		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				500.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	012	0	1	04	01	H3813_012_0	7		N	Vaccines	4	10	1	2	6	1	010		01	010		1	30								30						30		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	8		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	8		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	8		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				500.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	013	0	1	04	01	H3813_013_0	8		N	Vaccines	4	10	1	2	6	1	010		01	010		1	30								30						30		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	9		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				500.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3813	014	0	1	04	01	H3813_014_0	9		N	Vaccines	4	10	1	2	6	1	010		01	010		1	30								30						30		31	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3815	001	0	1	01	01	H3815_001_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	2		N	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	001	0	1	01	01	H3815_001_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	75.00																	37.00			30.00			1.23	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											929.00	33						929.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	006	0	1	01	01	H3815_006_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17.00	27.00	37.00					10.00	20.00	30.00					10.00	20.00	25.00																	17.00			10.00			0.57	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	100.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	232.50																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											932.00	33						932.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	007	0	1	01	01	H3815_007_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											703.00	33						703.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3		N	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	7.50																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3		N	Generic	4	01	3	2	2	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	7.50																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H3815	008	0	1	01	01	H3815_008_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	75.00																	37.00			30.00			1.23	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82.00	157.00	232.00					75.00	150.00	225.00					75.00	150.00	187.50																	82.00			75.00			2.73	2.50	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											769.00	33						769.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	009	0	1	01	01	H3815_009_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	009	0	1	01	01	H3815_009_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								20.00	40.00	60.00					14.00	28.00	42.00					14.00	28.00	42.00																	20.00			14.00			0.67	0.47	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	009	0	1	01	01	H3815_009_0	2		N	Preferred Brand	4	11	1	1	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											84.00	25	25	25				75.00	23	23	23				23	23	23																25		23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	009	0	1	01	01	H3815_009_0	2		N	Non-Preferred Drug	4	11	3	1	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											78.00	25	25	25				67.00	23	23	23				23	23	23																25		23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	009	0	1	01	01	H3815_009_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											646.00	25						646.00	25						25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	009	0	1	01	01	H3815_009_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3		N	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	010	0	1	01	01	H3815_010_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	75.00																	37.00			30.00			1.23	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82.00	157.00	232.00					75.00	150.00	225.00					75.00	150.00	187.50																	82.00			75.00			2.73	2.50	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											950.00	33						950.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	011	0	1	01	01	H3815_011_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17.00	27.00	37.00					10.00	20.00	30.00					10.00	20.00	25.00																	17.00			10.00			0.57	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	100.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	232.50																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											897.00	33						897.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	013	0	1	01	01	H3815_013_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	2		N	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	013	0	1	01	01	H3815_013_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17.00	27.00	37.00					10.00	20.00	30.00					10.00	20.00	25.00																	17.00			10.00			0.57	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	75.00																	37.00			30.00			1.23	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1044.00	33						1044.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	015	0	1	01	01	H3815_015_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	2		N	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	015	0	1	01	01	H3815_015_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	90.00																	37.00			30.00			1.23	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1066.00	33						1066.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	015	0	1	01	01	H3815_015_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	016	0	1	01	01	H3815_016_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	3		N	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	016	0	1	01	01	H3815_016_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	90.00																	37.00			30.00			1.23	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82.00	157.00	232.00					75.00	150.00	225.00					75.00	150.00	225.00																	82.00			75.00			2.73	2.50	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											911.00	33						911.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	016	0	1	01	01	H3815_016_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	018	0	1	01	01	H3815_018_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	2		N	Preferred Generic	4	11	1	2	1	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	018	0	1	01	01	H3815_018_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								37.00	67.00	97.00					30.00	60.00	90.00					30.00	60.00	90.00																	37.00			30.00			1.23	1.00	1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								82.00	157.00	232.00					75.00	150.00	225.00					75.00	150.00	225.00																	82.00			75.00			2.73	2.50	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1067.00	33						1067.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	018	0	1	01	01	H3815_018_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	019	0	1	01	01	H3815_019_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1069.00	33						1069.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	019	0	1	01	01	H3815_019_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	020	0	1	01	01	H3815_020_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1078.00	33						1078.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	020	0	1	01	01	H3815_020_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	021	0	1	01	01	H3815_021_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1075.00	33						1075.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	021	0	1	01	01	H3815_021_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	022	0	1	01	01	H3815_022_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	022	0	1	01	01	H3815_022_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	022	0	1	01	01	H3815_022_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	022	0	1	01	01	H3815_022_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	022	0	1	01	01	H3815_022_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1076.00	33						1076.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	022	0	1	01	01	H3815_022_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	022	0	1	01	01	H3815_022_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	023	0	1	01	01	H3815_023_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1069.00	33						1069.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	023	0	1	01	01	H3815_023_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	024	0	1	01	01	H3815_024_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	024	0	1	01	01	H3815_024_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	024	0	1	01	01	H3815_024_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	024	0	1	01	01	H3815_024_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	024	0	1	01	01	H3815_024_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1068.00	33						1068.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	024	0	1	01	01	H3815_024_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	024	0	1	01	01	H3815_024_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	025	0	1	01	01	H3815_025_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	12.50																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	025	0	1	01	01	H3815_025_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								17.00	27.00	37.00					10.00	20.00	30.00					10.00	20.00	25.00																	17.00			10.00			0.57	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	025	0	1	01	01	H3815_025_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	100.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	025	0	1	01	01	H3815_025_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	232.50																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	025	0	1	01	01	H3815_025_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											980.00	33						980.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	025	0	1	01	01	H3815_025_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	025	0	1	01	01	H3815_025_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	026	0	1	01	01	H3815_026_0	4		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	4		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	4		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											935.00	33						935.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	4		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	026	0	1	01	01	H3815_026_0	4		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	027	0	1	01	01	H3815_027_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											934.00	33						934.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	027	0	1	01	01	H3815_027_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	028	0	1	01	01	H3815_028_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											935.00	33						935.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	028	0	1	01	01	H3815_028_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	029	0	1	01	01	H3815_029_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											935.00	33						935.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	029	0	1	01	01	H3815_029_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	030	0	1	01	01	H3815_030_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	030	0	1	01	01	H3815_030_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								20.00	40.00	60.00					14.00	28.00	42.00					14.00	28.00	42.00																	20.00			14.00			0.67	0.47	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	030	0	1	01	01	H3815_030_0	3		N	Preferred Brand	4	11	1	1	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											84.00	25	25	25				75.00	23	23	23				23	23	23																25		23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	030	0	1	01	01	H3815_030_0	3		N	Non-Preferred Drug	4	11	3	1	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											79.00	25	25	25				67.00	23	23	23				23	23	23																25		23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	030	0	1	01	01	H3815_030_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											647.00	25						647.00	25						25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	030	0	1	01	01	H3815_030_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											935.00	33						935.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	031	0	1	01	01	H3815_031_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3815	032	0	1	01	01	H3815_032_0	2		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	2		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	2		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											933.00	33						933.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	2		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3815	032	0	1	01	01	H3815_032_0	2		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3817	008	1	1	04	01	H3817_008_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	1	1	04	01	H3817_008_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											852.48	30						852.48	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	008	2	1	04	01	H3817_008_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											852.48	30						852.48	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	1	1	04	01	H3817_009_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											937.73	33						937.73	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	009	2	1	04	01	H3817_009_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											937.73	33						937.73	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	1	1	04	01	H3817_011_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											795.65	28						795.65	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3817	011	2	1	04	01	H3817_011_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											795.65	28						795.65	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3822	001	0	1	01	01	H3822_001_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	5		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3822	002	0	1	01	01	H3822_002_0	5		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	5		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												28		28					28		28												28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3822	007	0	1	02	01	H3822_007_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3822	008	0	1	02	01	H3822_008_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3822	012	0	1	01	01	H3822_012_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	012	0	1	01	01	H3822_012_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	5.00	5.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	20.00	20.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	4		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3832	008	0	1	04	01	H3832_008_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	11.00	11.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	4		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.50	9.00	13.50																			4.50	4.50	4.50																4.50				4.50		0.15			0.15			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	12.00	12.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	4		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	4.00	4.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3832	010	0	1	04	01	H3832_010_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	11.00	11.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	4		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											81.45	33	33	33				71.24	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	014	0	1	02	01	H3864_014_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.06	33	33	33				67.80	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	021	0	1	01	01	H3864_021_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											87.07	33	33	33				83.01	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	024	0	1	02	01	H3864_024_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											88.26	33	33	33				81.91	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	027	0	1	01	01	H3864_027_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.40	32	32	32				94.71	31	31	31										32	32	32				31	31	31			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	029	0	1	02	01	H3864_029_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	02	01	H3864_029_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	02	01	H3864_029_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	02	01	H3864_029_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											85.84	33	33	33				80.95	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	02	01	H3864_029_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	02	01	H3864_029_0	4		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	029	0	1	02	01	H3864_029_0	4		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	032	0	1	01	01	H3864_032_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											69.94	33	33	33				66.08	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	032	0	1	01	01	H3864_032_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	033	0	1	01	01	H3864_033_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	01	01	H3864_033_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	01	01	H3864_033_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	01	01	H3864_033_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.38	33	33	33				65.42	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	01	01	H3864_033_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	01	01	H3864_033_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	033	0	1	01	01	H3864_033_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	034	0	1	01	01	H3864_034_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	01	01	H3864_034_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	01	01	H3864_034_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	01	01	H3864_034_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.04	33	33	33				74.56	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	01	01	H3864_034_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	01	01	H3864_034_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	034	0	1	01	01	H3864_034_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	036	0	1	01	01	H3864_036_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.81	33	33	33				81.21	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	036	0	1	01	01	H3864_036_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	037	0	1	01	01	H3864_037_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.72	33	33	33				70.79	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	037	0	1	01	01	H3864_037_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	038	0	1	01	01	H3864_038_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.92	33	33	33				61.45	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	038	0	1	01	01	H3864_038_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	039	0	1	01	01	H3864_039_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.07		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.13	33	33	33				61.92	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	039	0	1	01	01	H3864_039_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	040	0	1	01	01	H3864_040_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.05	33	33	33				69.74	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	040	0	1	01	01	H3864_040_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	041	0	1	01	01	H3864_041_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	5		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.17	33	33	33				72.84	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	041	0	1	01	01	H3864_041_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3890	001	0	1	04	01	H3890_001_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	10.50	14.00																			7.00	10.50	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	22.50	30.00																			15.00	22.50	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	70.50	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	6.00	8.00																			4.00	6.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	18.00	24.00																			12.00	18.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	70.50	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	150.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	004	0	1	04	01	H3890_004_0	8		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	4.50	6.00																			3.00	4.50	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	004	0	1	04	01	H3890_004_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	15.00	20.00																			10.00	15.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	004	0	1	04	01	H3890_004_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	60.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	004	0	1	04	01	H3890_004_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	135.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	004	0	1	04	01	H3890_004_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	10		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	10		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											930.21	33						751.56	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	11		Y	Preferred Generic	4	11	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	11		Y	Preferred Generic	4	11	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H3907	029	0	1	01	01	H3907_029_0	11		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	11		Y	Generic	4	11	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H3907	029	0	1	01	01	H3907_029_0	11		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	029	0	1	01	01	H3907_029_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											927.55	33						746.11	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	10		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	10		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	037	0	1	01	01	H3907_037_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											968.41	33						728.25	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	9		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	9		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	045	0	1	01	01	H3907_045_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1198.22	33						798.99	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	8		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	046	0	1	01	01	H3907_046_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											978.12	33						746.24	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	047	0	1	01	01	H3907_047_0	9		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	047	0	1	01	01	H3907_047_0	9		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	047	0	1	01	01	H3907_047_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	047	0	1	01	01	H3907_047_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	047	0	1	01	01	H3907_047_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											885.94	33						738.82	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	9		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	9		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	049	0	1	01	01	H3907_049_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1133.81	33						673.20	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	8		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	050	0	1	01	01	H3907_050_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											961.15	33						770.16	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	8		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	051	0	1	01	01	H3907_051_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1142.26	33						686.44	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	8		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	052	0	1	01	01	H3907_052_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											974.97	33						743.54	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	7		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	7		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	014	0	1	04	01	H3909_014_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	014	0	1	04	01	H3909_014_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	014	0	1	04	01	H3909_014_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	014	0	1	04	01	H3909_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	014	0	1	04	01	H3909_014_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	015	0	1	04	01	H3909_015_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	015	0	1	04	01	H3909_015_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	015	0	1	04	01	H3909_015_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	015	0	1	04	01	H3909_015_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	015	0	1	04	01	H3909_015_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	001	0	1	04	01	H3916_001_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7		N	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	001	0	1	04	01	H3916_001_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1031.88	33						1031.88	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7		N	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											930.68	33						930.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7		N	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1135.08	33						1135.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1177.30	33						1177.30	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											958.76	33						958.76	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1025.42	33						1025.42	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1308.25	33						1308.25	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1004.33	33						1004.33	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1244.20	33						1244.20	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	8		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	8		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	8		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	1	1	04	01	H3916_034_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1243.06	33						1243.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	8		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	8		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	8		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	3	1	04	01	H3916_034_3	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1243.06	33						1243.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	8		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	8		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	8		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	4	1	04	01	H3916_034_4	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1243.06	33						1243.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	8		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	8		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	8		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	034	5	1	04	01	H3916_034_5	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1243.06	33						1243.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					9.00		27.00													60.00						27.00				20.00				20.00			0.65	0.29				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						280.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	1	1	04	01	H3916_035_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1005.98	33						1005.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					9.00		27.00													60.00						27.00				20.00				20.00			0.65	0.29				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						280.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	035	2	1	04	01	H3916_035_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1005.98	33						1005.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	036	0	1	04	01	H3916_036_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											887.24	33						887.24	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	1	1	04	01	H3916_037_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											962.74	33						962.74	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	2	1	04	01	H3916_037_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											962.74	33						962.74	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	3	1	04	01	H3916_037_3	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											962.74	33						962.74	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	037	4	1	04	01	H3916_037_4	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											962.74	33						962.74	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	038	0	1	04	01	H3916_038_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											917.09	33						917.09	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	039	0	1	04	01	H3916_039_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											873.54	33						873.54	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	013	0	1	04	01	H3923_013_0	6		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	013	0	1	04	01	H3923_013_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	013	0	1	04	01	H3923_013_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	279.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	013	0	1	04	01	H3923_013_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1038.29	33						1038.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	013	0	1	04	01	H3923_013_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								8.00	16.00	24.00					0.00	0.00	0.00											8.00	16.00	24.00				0.00	0.00	0.00					8.00			8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	6		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	6		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	279.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1220.37	33						1220.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	017	0	1	04	01	H3923_017_0	6		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	24.00					15.00			15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00					20.00			20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7		N	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	279.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1038.29	33						1038.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3923	028	0	1	04	01	H3923_028_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3924	059	13	1	04	01	H3924_059_13	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	13	1	04	01	H3924_059_13	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	13	1	04	01	H3924_059_13	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	13	1	04	01	H3924_059_13	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	13	1	04	01	H3924_059_13	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	13	1	04	01	H3924_059_13	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	13	1	04	01	H3924_059_13	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	13	1	04	01	H3924_059_13	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	14	1	04	01	H3924_059_14	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	14	1	04	01	H3924_059_14	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	14	1	04	01	H3924_059_14	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	14	1	04	01	H3924_059_14	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	14	1	04	01	H3924_059_14	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	14	1	04	01	H3924_059_14	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	14	1	04	01	H3924_059_14	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	14	1	04	01	H3924_059_14	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	15	1	04	01	H3924_059_15	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	15	1	04	01	H3924_059_15	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	15	1	04	01	H3924_059_15	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	15	1	04	01	H3924_059_15	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	15	1	04	01	H3924_059_15	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	15	1	04	01	H3924_059_15	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	15	1	04	01	H3924_059_15	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	15	1	04	01	H3924_059_15	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	16	1	04	01	H3924_059_16	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	16	1	04	01	H3924_059_16	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	16	1	04	01	H3924_059_16	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	16	1	04	01	H3924_059_16	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	16	1	04	01	H3924_059_16	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	16	1	04	01	H3924_059_16	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	16	1	04	01	H3924_059_16	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	16	1	04	01	H3924_059_16	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	17	1	04	01	H3924_059_17	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	17	1	04	01	H3924_059_17	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	17	1	04	01	H3924_059_17	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	17	1	04	01	H3924_059_17	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	17	1	04	01	H3924_059_17	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	17	1	04	01	H3924_059_17	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	17	1	04	01	H3924_059_17	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	17	1	04	01	H3924_059_17	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	18	1	04	01	H3924_059_18	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	18	1	04	01	H3924_059_18	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	059	18	1	04	01	H3924_059_18	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	18	1	04	01	H3924_059_18	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	18	1	04	01	H3924_059_18	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	18	1	04	01	H3924_059_18	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	18	1	04	01	H3924_059_18	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	059	18	1	04	01	H3924_059_18	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	13	1	04	01	H3924_060_13	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	13	1	04	01	H3924_060_13	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	13	1	04	01	H3924_060_13	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	13	1	04	01	H3924_060_13	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	13	1	04	01	H3924_060_13	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	13	1	04	01	H3924_060_13	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	13	1	04	01	H3924_060_13	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	13	1	04	01	H3924_060_13	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	14	1	04	01	H3924_060_14	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	14	1	04	01	H3924_060_14	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	14	1	04	01	H3924_060_14	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	14	1	04	01	H3924_060_14	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	14	1	04	01	H3924_060_14	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	14	1	04	01	H3924_060_14	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	14	1	04	01	H3924_060_14	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	14	1	04	01	H3924_060_14	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	15	1	04	01	H3924_060_15	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	15	1	04	01	H3924_060_15	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	15	1	04	01	H3924_060_15	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	15	1	04	01	H3924_060_15	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	15	1	04	01	H3924_060_15	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	15	1	04	01	H3924_060_15	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	15	1	04	01	H3924_060_15	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	15	1	04	01	H3924_060_15	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	16	1	04	01	H3924_060_16	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	16	1	04	01	H3924_060_16	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	16	1	04	01	H3924_060_16	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	16	1	04	01	H3924_060_16	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	16	1	04	01	H3924_060_16	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	16	1	04	01	H3924_060_16	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	16	1	04	01	H3924_060_16	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	16	1	04	01	H3924_060_16	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	17	1	04	01	H3924_060_17	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	17	1	04	01	H3924_060_17	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	17	1	04	01	H3924_060_17	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	17	1	04	01	H3924_060_17	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	17	1	04	01	H3924_060_17	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	17	1	04	01	H3924_060_17	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	17	1	04	01	H3924_060_17	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	17	1	04	01	H3924_060_17	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	18	1	04	01	H3924_060_18	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	18	1	04	01	H3924_060_18	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	060	18	1	04	01	H3924_060_18	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	18	1	04	01	H3924_060_18	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	18	1	04	01	H3924_060_18	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	18	1	04	01	H3924_060_18	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	18	1	04	01	H3924_060_18	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	060	18	1	04	01	H3924_060_18	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	21	1	04	01	H3924_062_21	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	21	1	04	01	H3924_062_21	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		12.50																			0.00		0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	21	1	04	01	H3924_062_21	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	22	1	04	01	H3924_062_22	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	062	22	1	04	01	H3924_062_22	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		12.50																			0.00		0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	062	22	1	04	01	H3924_062_22	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	064	1	1	04	01	H3924_064_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	1	1	04	01	H3924_064_1	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	064	1	1	04	01	H3924_064_1	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		12.50																			0.00		0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	1	1	04	01	H3924_064_1	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	1	1	04	01	H3924_064_1	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	1	1	04	01	H3924_064_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	1	1	04	01	H3924_064_1	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	1	1	04	01	H3924_064_1	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	064	2	1	04	01	H3924_064_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	2	1	04	01	H3924_064_2	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3924	064	2	1	04	01	H3924_064_2	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		12.50																			0.00		0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	2	1	04	01	H3924_064_2	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	2	1	04	01	H3924_064_2	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	2	1	04	01	H3924_064_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	2	1	04	01	H3924_064_2	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3924	064	2	1	04	01	H3924_064_2	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3928	001	0	1	01	01	H3928_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	001	0	1	01	01	H3928_001_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	001	0	1	01	01	H3928_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	001	0	1	01	01	H3928_001_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	001	0	1	01	01	H3928_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	001	0	1	01	01	H3928_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	001	0	1	01	01	H3928_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											629.85	30						454.38	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	002	0	1	01	01	H3928_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	002	0	1	01	01	H3928_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	002	0	1	01	01	H3928_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	002	0	1	01	01	H3928_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	002	0	1	01	01	H3928_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	002	0	1	01	01	H3928_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3928	002	0	1	01	01	H3928_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											605.16	30						431.55	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	004	0	1	01	01	H3931_004_0	4		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3931	004	0	1	01	01	H3931_004_0	4		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3931	004	0	1	01	01	H3931_004_0	4		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3931	004	0	1	01	01	H3931_004_0	4		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3931	004	0	1	01	01	H3931_004_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	004	0	1	01	01	H3931_004_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	004	0	1	01	01	H3931_004_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											710.38	33						558.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	064	0	1	01	01	H3931_064_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	064	0	1	01	01	H3931_064_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	064	0	1	01	01	H3931_064_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	064	0	1	01	01	H3931_064_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	064	0	1	01	01	H3931_064_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	064	0	1	01	01	H3931_064_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	064	0	1	01	01	H3931_064_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											981.89	33						475.26	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	070	0	1	01	01	H3931_070_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	070	0	1	01	01	H3931_070_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	070	0	1	01	01	H3931_070_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	070	0	1	01	01	H3931_070_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	070	0	1	01	01	H3931_070_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	070	0	1	01	01	H3931_070_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	070	0	1	01	01	H3931_070_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											740.78	33						544.66	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	091	0	1	01	01	H3931_091_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	091	0	1	01	01	H3931_091_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	091	0	1	01	01	H3931_091_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	091	0	1	01	01	H3931_091_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	091	0	1	01	01	H3931_091_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	091	0	1	01	01	H3931_091_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	091	0	1	01	01	H3931_091_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											632.94	33						487.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	092	0	1	01	01	H3931_092_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	092	0	1	01	01	H3931_092_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	092	0	1	01	01	H3931_092_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	092	0	1	01	01	H3931_092_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	092	0	1	01	01	H3931_092_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	092	0	1	01	01	H3931_092_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	092	0	1	01	01	H3931_092_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											906.00	31						446.45	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	093	0	1	01	01	H3931_093_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	093	0	1	01	01	H3931_093_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	093	0	1	01	01	H3931_093_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	093	0	1	01	01	H3931_093_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	093	0	1	01	01	H3931_093_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	093	0	1	01	01	H3931_093_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	093	0	1	01	01	H3931_093_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											712.24	33						494.67	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	094	0	1	01	01	H3931_094_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	094	0	1	01	01	H3931_094_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	094	0	1	01	01	H3931_094_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	094	0	1	01	01	H3931_094_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	094	0	1	01	01	H3931_094_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	094	0	1	01	01	H3931_094_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	094	0	1	01	01	H3931_094_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											828.28	31						502.18	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	095	0	1	01	01	H3931_095_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	095	0	1	01	01	H3931_095_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	095	0	1	01	01	H3931_095_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	095	0	1	01	01	H3931_095_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	095	0	1	01	01	H3931_095_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	095	0	1	01	01	H3931_095_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	095	0	1	01	01	H3931_095_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											517.88	29						402.16	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	096	0	1	01	01	H3931_096_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	096	0	1	01	01	H3931_096_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	096	0	1	01	01	H3931_096_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	096	0	1	01	01	H3931_096_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	096	0	1	01	01	H3931_096_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	096	0	1	01	01	H3931_096_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	096	0	1	01	01	H3931_096_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											516.90	28						371.12	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	097	0	1	01	01	H3931_097_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	097	0	1	01	01	H3931_097_0	2		N	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	097	0	1	01	01	H3931_097_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	097	0	1	01	01	H3931_097_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	097	0	1	01	01	H3931_097_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											490.71	28						369.31	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	098	0	1	01	01	H3931_098_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	098	0	1	01	01	H3931_098_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	098	0	1	01	01	H3931_098_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	098	0	1	01	01	H3931_098_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	098	0	1	01	01	H3931_098_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	098	0	1	01	01	H3931_098_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	098	0	1	01	01	H3931_098_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											520.67	29						395.87	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	099	0	1	01	01	H3931_099_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	099	0	1	01	01	H3931_099_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	099	0	1	01	01	H3931_099_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	099	0	1	01	01	H3931_099_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	099	0	1	01	01	H3931_099_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	099	0	1	01	01	H3931_099_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	099	0	1	01	01	H3931_099_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											724.87	29						493.70	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	100	0	1	01	01	H3931_100_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	100	0	1	01	01	H3931_100_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	100	0	1	01	01	H3931_100_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	100	0	1	01	01	H3931_100_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	100	0	1	01	01	H3931_100_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	100	0	1	01	01	H3931_100_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	100	0	1	01	01	H3931_100_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											535.61	29						375.58	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	101	0	1	01	01	H3931_101_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	101	0	1	01	01	H3931_101_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	101	0	1	01	01	H3931_101_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	101	0	1	01	01	H3931_101_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	101	0	1	01	01	H3931_101_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	101	0	1	01	01	H3931_101_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	101	0	1	01	01	H3931_101_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											600.92	29						439.03	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	102	0	1	01	01	H3931_102_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3931	102	0	1	01	01	H3931_102_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3931	102	0	1	01	01	H3931_102_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3931	102	0	1	01	01	H3931_102_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3931	102	0	1	01	01	H3931_102_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	102	0	1	01	01	H3931_102_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	102	0	1	01	01	H3931_102_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											680.17	33						524.67	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	104	0	1	01	01	H3931_104_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	104	0	1	01	01	H3931_104_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	104	0	1	01	01	H3931_104_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	104	0	1	01	01	H3931_104_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	104	0	1	01	01	H3931_104_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	104	0	1	01	01	H3931_104_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	104	0	1	01	01	H3931_104_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											605.27	31						467.77	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	105	0	1	01	01	H3931_105_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	105	0	1	01	01	H3931_105_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	105	0	1	01	01	H3931_105_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	105	0	1	01	01	H3931_105_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	105	0	1	01	01	H3931_105_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	105	0	1	01	01	H3931_105_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	105	0	1	01	01	H3931_105_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											682.52	30						508.58	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	107	0	1	01	01	H3931_107_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	107	0	1	01	01	H3931_107_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	107	0	1	01	01	H3931_107_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	107	0	1	01	01	H3931_107_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	107	0	1	01	01	H3931_107_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	107	0	1	01	01	H3931_107_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	107	0	1	01	01	H3931_107_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											935.76	30						491.32	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	108	0	1	01	01	H3931_108_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	108	0	1	01	01	H3931_108_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	108	0	1	01	01	H3931_108_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	108	0	1	01	01	H3931_108_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	108	0	1	01	01	H3931_108_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	108	0	1	01	01	H3931_108_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	108	0	1	01	01	H3931_108_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											700.36	30						459.36	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	109	0	1	01	01	H3931_109_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	109	0	1	01	01	H3931_109_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	109	0	1	01	01	H3931_109_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	109	0	1	01	01	H3931_109_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	109	0	1	01	01	H3931_109_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	109	0	1	01	01	H3931_109_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	109	0	1	01	01	H3931_109_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											761.30	30						518.58	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	112	0	1	01	01	H3931_112_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	112	0	1	01	01	H3931_112_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	112	0	1	01	01	H3931_112_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	112	0	1	01	01	H3931_112_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	112	0	1	01	01	H3931_112_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	112	0	1	01	01	H3931_112_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	112	0	1	01	01	H3931_112_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											686.52	30						536.19	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	115	0	1	01	01	H3931_115_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	115	0	1	01	01	H3931_115_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	115	0	1	01	01	H3931_115_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	115	0	1	01	01	H3931_115_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	115	0	1	01	01	H3931_115_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	115	0	1	01	01	H3931_115_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	115	0	1	01	01	H3931_115_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											703.71	31						513.65	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	118	0	1	01	01	H3931_118_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	118	0	1	01	01	H3931_118_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	118	0	1	01	01	H3931_118_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	118	0	1	01	01	H3931_118_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	118	0	1	01	01	H3931_118_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	118	0	1	01	01	H3931_118_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	118	0	1	01	01	H3931_118_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											693.76	30						495.74	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	124	0	1	01	01	H3931_124_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	124	0	1	01	01	H3931_124_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	124	0	1	01	01	H3931_124_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	124	0	1	01	01	H3931_124_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	124	0	1	01	01	H3931_124_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	124	0	1	01	01	H3931_124_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	124	0	1	01	01	H3931_124_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											576.92	29						433.16	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	126	0	1	01	01	H3931_126_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	126	0	1	01	01	H3931_126_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	126	0	1	01	01	H3931_126_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	126	0	1	01	01	H3931_126_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	126	0	1	01	01	H3931_126_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	126	0	1	01	01	H3931_126_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	126	0	1	01	01	H3931_126_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											855.73	33						528.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	129	0	1	01	01	H3931_129_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	129	0	1	01	01	H3931_129_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	129	0	1	01	01	H3931_129_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	129	0	1	01	01	H3931_129_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	129	0	1	01	01	H3931_129_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	129	0	1	01	01	H3931_129_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	129	0	1	01	01	H3931_129_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											661.92	31						483.56	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	130	0	1	01	01	H3931_130_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	130	0	1	01	01	H3931_130_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	130	0	1	01	01	H3931_130_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	130	0	1	01	01	H3931_130_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	130	0	1	01	01	H3931_130_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	130	0	1	01	01	H3931_130_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	130	0	1	01	01	H3931_130_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											732.88	31						557.53	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	131	0	1	01	01	H3931_131_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	131	0	1	01	01	H3931_131_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	131	0	1	01	01	H3931_131_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	131	0	1	01	01	H3931_131_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	131	0	1	01	01	H3931_131_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	131	0	1	01	01	H3931_131_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	131	0	1	01	01	H3931_131_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											627.49	27						430.55	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	133	0	1	01	01	H3931_133_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	133	0	1	01	01	H3931_133_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	133	0	1	01	01	H3931_133_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	133	0	1	01	01	H3931_133_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	133	0	1	01	01	H3931_133_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	133	0	1	01	01	H3931_133_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	133	0	1	01	01	H3931_133_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											607.54	29						429.78	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	134	0	1	01	01	H3931_134_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	134	0	1	01	01	H3931_134_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	134	0	1	01	01	H3931_134_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	134	0	1	01	01	H3931_134_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	134	0	1	01	01	H3931_134_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	134	0	1	01	01	H3931_134_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	134	0	1	01	01	H3931_134_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											739.20	30						515.14	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	140	0	1	01	01	H3931_140_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	140	0	1	01	01	H3931_140_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	140	0	1	01	01	H3931_140_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	140	0	1	01	01	H3931_140_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	140	0	1	01	01	H3931_140_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	140	0	1	01	01	H3931_140_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3931	140	0	1	01	01	H3931_140_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											716.83	30						525.38	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3949	013	0	1	01	01	H3949_013_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				0.00			0.30	0.00		0.30	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3949	013	0	1	01	01	H3949_013_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											793.31	33						680.86	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	024	0	1	01	01	H3949_024_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											831.46	33						637.41	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	6		N	Select Diabetic Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	10.00					5.00	10.00	10.00											5.00	10.00	10.00				5.00	10.00	10.00				5.00				5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	030	0	1	01	01	H3949_030_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				0.00			0.30	0.00		0.30	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3949	030	0	1	01	01	H3949_030_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											767.96	33						692.09	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3949	031	0	1	01	01	H3949_031_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	031	0	1	01	01	H3949_031_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											847.21	33						683.06	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3949	032	0	1	01	01	H3949_032_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	032	0	1	01	01	H3949_032_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											799.04	33						713.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	033	0	1	01	01	H3949_033_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	033	0	1	01	01	H3949_033_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3949	033	0	1	01	01	H3949_033_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	033	0	1	01	01	H3949_033_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	033	0	1	01	01	H3949_033_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	033	0	1	01	01	H3949_033_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											799.04	33						713.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3949	034	0	1	01	01	H3949_034_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	034	0	1	01	01	H3949_034_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											799.04	33						713.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	035	0	1	01	01	H3949_035_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	035	0	1	01	01	H3949_035_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3949	035	0	1	01	01	H3949_035_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	035	0	1	01	01	H3949_035_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	035	0	1	01	01	H3949_035_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	035	0	1	01	01	H3949_035_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											799.04	33						713.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	5		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					9.00	18.00	18.00					9.00	18.00	18.00																20.00				20.00			0.67	0.30	0.30			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	5		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	02	01	H3952_053_0	7		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	02	01	H3952_054_0	7		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_055_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_055_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_055_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_055_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	055	0	1	01	01	H3952_055_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					1.00	2.00	2.00					1.00	2.00	2.00																9.00				9.00			0.30	0.03	0.03			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	056	0	1	01	01	H3952_056_0	6		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3954	157	13	1	01	01	H3954_157_13	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	13	1	01	01	H3954_157_13	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	13	1	01	01	H3954_157_13	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			0.00		0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	13	1	01	01	H3954_157_13	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	13	1	01	01	H3954_157_13	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	13	1	01	01	H3954_157_13	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	13	1	01	01	H3954_157_13	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	13	1	01	01	H3954_157_13	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	14	1	01	01	H3954_157_14	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	14	1	01	01	H3954_157_14	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	14	1	01	01	H3954_157_14	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			0.00		0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	14	1	01	01	H3954_157_14	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	14	1	01	01	H3954_157_14	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	14	1	01	01	H3954_157_14	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	14	1	01	01	H3954_157_14	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	14	1	01	01	H3954_157_14	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	15	1	01	01	H3954_157_15	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	15	1	01	01	H3954_157_15	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	15	1	01	01	H3954_157_15	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			0.00		0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	15	1	01	01	H3954_157_15	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	15	1	01	01	H3954_157_15	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	15	1	01	01	H3954_157_15	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	15	1	01	01	H3954_157_15	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	15	1	01	01	H3954_157_15	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	16	1	01	01	H3954_157_16	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	16	1	01	01	H3954_157_16	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	16	1	01	01	H3954_157_16	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			0.00		0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	16	1	01	01	H3954_157_16	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	16	1	01	01	H3954_157_16	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	16	1	01	01	H3954_157_16	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	16	1	01	01	H3954_157_16	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	16	1	01	01	H3954_157_16	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	17	1	01	01	H3954_157_17	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	17	1	01	01	H3954_157_17	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	17	1	01	01	H3954_157_17	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			0.00		0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	17	1	01	01	H3954_157_17	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	17	1	01	01	H3954_157_17	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	17	1	01	01	H3954_157_17	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	17	1	01	01	H3954_157_17	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	17	1	01	01	H3954_157_17	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	18	1	01	01	H3954_157_18	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	18	1	01	01	H3954_157_18	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	157	18	1	01	01	H3954_157_18	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			0.00		0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	18	1	01	01	H3954_157_18	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	18	1	01	01	H3954_157_18	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	18	1	01	01	H3954_157_18	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	18	1	01	01	H3954_157_18	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	157	18	1	01	01	H3954_157_18	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	13	1	01	01	H3954_158_13	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	13	1	01	01	H3954_158_13	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	13	1	01	01	H3954_158_13	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	14	1	01	01	H3954_158_14	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	14	1	01	01	H3954_158_14	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	14	1	01	01	H3954_158_14	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	15	1	01	01	H3954_158_15	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	15	1	01	01	H3954_158_15	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	15	1	01	01	H3954_158_15	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	15	1	01	01	H3954_158_15	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	15	1	01	01	H3954_158_15	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	15	1	01	01	H3954_158_15	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	15	1	01	01	H3954_158_15	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	15	1	01	01	H3954_158_15	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	16	1	01	01	H3954_158_16	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	16	1	01	01	H3954_158_16	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	16	1	01	01	H3954_158_16	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	16	1	01	01	H3954_158_16	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	16	1	01	01	H3954_158_16	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	16	1	01	01	H3954_158_16	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	16	1	01	01	H3954_158_16	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	16	1	01	01	H3954_158_16	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	17	1	01	01	H3954_158_17	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	17	1	01	01	H3954_158_17	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	17	1	01	01	H3954_158_17	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	17	1	01	01	H3954_158_17	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	17	1	01	01	H3954_158_17	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	17	1	01	01	H3954_158_17	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	17	1	01	01	H3954_158_17	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	17	1	01	01	H3954_158_17	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	18	1	01	01	H3954_158_18	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	18	1	01	01	H3954_158_18	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	158	18	1	01	01	H3954_158_18	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	18	1	01	01	H3954_158_18	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	18	1	01	01	H3954_158_18	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	18	1	01	01	H3954_158_18	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	18	1	01	01	H3954_158_18	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	158	18	1	01	01	H3954_158_18	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	13	1	01	01	H3954_159_13	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	13	1	01	01	H3954_159_13	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	13	1	01	01	H3954_159_13	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	13	1	01	01	H3954_159_13	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	13	1	01	01	H3954_159_13	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	13	1	01	01	H3954_159_13	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	13	1	01	01	H3954_159_13	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	13	1	01	01	H3954_159_13	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	14	1	01	01	H3954_159_14	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	14	1	01	01	H3954_159_14	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	14	1	01	01	H3954_159_14	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	14	1	01	01	H3954_159_14	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	14	1	01	01	H3954_159_14	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	14	1	01	01	H3954_159_14	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	14	1	01	01	H3954_159_14	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	14	1	01	01	H3954_159_14	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	15	1	01	01	H3954_159_15	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	15	1	01	01	H3954_159_15	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	15	1	01	01	H3954_159_15	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	15	1	01	01	H3954_159_15	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	15	1	01	01	H3954_159_15	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	15	1	01	01	H3954_159_15	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	15	1	01	01	H3954_159_15	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	15	1	01	01	H3954_159_15	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	16	1	01	01	H3954_159_16	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	16	1	01	01	H3954_159_16	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	16	1	01	01	H3954_159_16	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	16	1	01	01	H3954_159_16	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	16	1	01	01	H3954_159_16	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	16	1	01	01	H3954_159_16	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	16	1	01	01	H3954_159_16	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	16	1	01	01	H3954_159_16	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	17	1	01	01	H3954_159_17	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	17	1	01	01	H3954_159_17	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	17	1	01	01	H3954_159_17	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	17	1	01	01	H3954_159_17	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	17	1	01	01	H3954_159_17	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	17	1	01	01	H3954_159_17	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	17	1	01	01	H3954_159_17	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	17	1	01	01	H3954_159_17	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	18	1	01	01	H3954_159_18	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	18	1	01	01	H3954_159_18	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			3.00		4.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	159	18	1	01	01	H3954_159_18	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			20.00		30.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	18	1	01	01	H3954_159_18	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	18	1	01	01	H3954_159_18	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	18	1	01	01	H3954_159_18	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	18	1	01	01	H3954_159_18	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	159	18	1	01	01	H3954_159_18	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	160	0	1	01	01	H3954_160_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	3.00		7.50																			0.00		0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3954	160	0	1	01	01	H3954_160_0	3		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		50.00																			0.00		0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	3		Y	Preferred Brand	4	10	1	2	3	1	110		01	110		1	30		100				2	2	30		100				30		31	47.00		117.50																			47.00		70.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	3		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	100.00		250.00																			100.00		150.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	3		Y	Vaccines	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3954	160	0	1	01	01	H3954_160_0	3		Y	Vaccines	4	11	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3957	031	0	1	02	01	H3957_031_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	02	01	H3957_031_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											963.22	33						963.22	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7		N	Generic	4	01	1	2	2	3		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											963.02	33						963.02	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	1	1	01	01	H3957_042_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											990.35	33						990.35	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	2	1	01	01	H3957_042_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											990.35	33						990.35	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	4	1	01	01	H3957_042_4	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											990.35	33						990.35	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	042	5	1	01	01	H3957_042_5	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											990.35	33						990.35	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	1	1	02	01	H3957_044_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1100.08	33						1100.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	2	1	02	01	H3957_044_2	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	2	1	02	01	H3957_044_2	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					13.00		39.00													57.00						27.00				19.00				19.00			0.61	0.42				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	2	1	02	01	H3957_044_2	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	2	1	02	01	H3957_044_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					95.00		285.00													300.00						275.00				100.00				100.00			3.23	3.06				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	044	2	1	02	01	H3957_044_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1100.08	33						1100.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	7		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	1	1	02	01	H3957_045_1	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1018.07	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	7		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	2	1	02	01	H3957_045_2	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1018.07	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	3	1	02	01	H3957_045_3	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	3	1	02	01	H3957_045_3	7		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	3	1	02	01	H3957_045_3	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	3	1	02	01	H3957_045_3	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	045	3	1	02	01	H3957_045_3	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1018.07	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	7		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	1	1	02	01	H3957_046_1	7		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	7		N	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	1	1	02	01	H3957_046_1	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	1	1	02	01	H3957_046_1	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				981.41	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	7		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	2	1	02	01	H3957_046_2	7		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	7		N	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	2	1	02	01	H3957_046_2	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	2	1	02	01	H3957_046_2	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				981.41	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	3	1	02	01	H3957_046_3	7		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	3	1	02	01	H3957_046_3	7		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	3	1	02	01	H3957_046_3	7		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	3	1	02	01	H3957_046_3	7		N	Generic	4	01	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	046	3	1	02	01	H3957_046_3	7		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	3	1	02	01	H3957_046_3	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					250.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	046	3	1	02	01	H3957_046_3	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				981.41	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	1	1	01	01	H3957_047_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1039.87	33						1039.87	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	047	2	1	01	01	H3957_047_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1039.87	33						1039.87	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	001	0	1	01	01	H3959_001_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	001	0	1	01	01	H3959_001_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	001	0	1	01	01	H3959_001_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	001	0	1	01	01	H3959_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	001	0	1	01	01	H3959_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	001	0	1	01	01	H3959_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											690.80	33						383.13	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	002	0	1	01	01	H3959_002_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	002	0	1	01	01	H3959_002_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	002	0	1	01	01	H3959_002_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	002	0	1	01	01	H3959_002_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	002	0	1	01	01	H3959_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	002	0	1	01	01	H3959_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	002	0	1	01	01	H3959_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											887.21	33						417.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	010	0	1	01	01	H3959_010_0	4		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	010	0	1	01	01	H3959_010_0	4		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	010	0	1	01	01	H3959_010_0	4		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	010	0	1	01	01	H3959_010_0	4		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	010	0	1	01	01	H3959_010_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	010	0	1	01	01	H3959_010_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	010	0	1	01	01	H3959_010_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											756.23	33						444.48	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	011	0	1	01	01	H3959_011_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	011	0	1	01	01	H3959_011_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	011	0	1	01	01	H3959_011_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	011	0	1	01	01	H3959_011_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	011	0	1	01	01	H3959_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	011	0	1	01	01	H3959_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	011	0	1	01	01	H3959_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											727.04	33						589.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	032	0	1	01	01	H3959_032_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	032	0	1	01	01	H3959_032_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	032	0	1	01	01	H3959_032_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	032	0	1	01	01	H3959_032_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	032	0	1	01	01	H3959_032_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	032	0	1	01	01	H3959_032_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	032	0	1	01	01	H3959_032_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1107.64	33						651.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	033	0	1	01	01	H3959_033_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	033	0	1	01	01	H3959_033_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	033	0	1	01	01	H3959_033_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	033	0	1	01	01	H3959_033_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	033	0	1	01	01	H3959_033_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	033	0	1	01	01	H3959_033_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	033	0	1	01	01	H3959_033_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											747.20	30						597.55	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	035	0	1	01	01	H3959_035_0	2		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	035	0	1	01	01	H3959_035_0	2		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	035	0	1	01	01	H3959_035_0	2		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	035	0	1	01	01	H3959_035_0	2		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	035	0	1	01	01	H3959_035_0	2		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				518.19	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	036	0	1	01	01	H3959_036_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	036	0	1	01	01	H3959_036_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	036	0	1	01	01	H3959_036_0	2		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.27	25	25	25				31.15	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	036	0	1	01	01	H3959_036_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.33	35	35	35				49.58	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	036	0	1	01	01	H3959_036_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											492.71	29						373.53	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	037	0	1	01	01	H3959_037_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	037	0	1	01	01	H3959_037_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	037	0	1	01	01	H3959_037_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	037	0	1	01	01	H3959_037_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	037	0	1	01	01	H3959_037_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	037	0	1	01	01	H3959_037_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	037	0	1	01	01	H3959_037_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											728.58	33						457.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	039	0	1	01	01	H3959_039_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	039	0	1	01	01	H3959_039_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	039	0	1	01	01	H3959_039_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	039	0	1	01	01	H3959_039_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	039	0	1	01	01	H3959_039_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	039	0	1	01	01	H3959_039_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	039	0	1	01	01	H3959_039_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											971.02	33						664.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	045	0	1	01	01	H3959_045_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	045	0	1	01	01	H3959_045_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	045	0	1	01	01	H3959_045_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	045	0	1	01	01	H3959_045_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	045	0	1	01	01	H3959_045_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	045	0	1	01	01	H3959_045_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	045	0	1	01	01	H3959_045_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											651.76	33						504.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	046	0	1	01	01	H3959_046_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	046	0	1	01	01	H3959_046_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	046	0	1	01	01	H3959_046_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	046	0	1	01	01	H3959_046_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	046	0	1	01	01	H3959_046_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	046	0	1	01	01	H3959_046_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	046	0	1	01	01	H3959_046_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											825.24	33						595.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	047	0	1	01	01	H3959_047_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	047	0	1	01	01	H3959_047_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	047	0	1	01	01	H3959_047_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	047	0	1	01	01	H3959_047_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	047	0	1	01	01	H3959_047_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	047	0	1	01	01	H3959_047_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	047	0	1	01	01	H3959_047_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											813.32	33						640.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	049	0	1	01	01	H3959_049_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	049	0	1	01	01	H3959_049_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	049	0	1	01	01	H3959_049_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	049	0	1	01	01	H3959_049_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	049	0	1	01	01	H3959_049_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	049	0	1	01	01	H3959_049_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	049	0	1	01	01	H3959_049_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											738.39	33						583.73	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	051	0	1	01	01	H3959_051_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	051	0	1	01	01	H3959_051_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	051	0	1	01	01	H3959_051_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	051	0	1	01	01	H3959_051_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	051	0	1	01	01	H3959_051_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	051	0	1	01	01	H3959_051_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	051	0	1	01	01	H3959_051_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											763.17	33						612.06	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	052	0	1	01	01	H3959_052_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	052	0	1	01	01	H3959_052_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	052	0	1	01	01	H3959_052_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	052	0	1	01	01	H3959_052_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	052	0	1	01	01	H3959_052_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	052	0	1	01	01	H3959_052_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	052	0	1	01	01	H3959_052_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											775.76	33						540.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	053	0	1	01	01	H3959_053_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	053	0	1	01	01	H3959_053_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	053	0	1	01	01	H3959_053_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H3959	053	0	1	01	01	H3959_053_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H3959	053	0	1	01	01	H3959_053_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	053	0	1	01	01	H3959_053_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	053	0	1	01	01	H3959_053_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											706.94	33						541.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	055	0	1	01	01	H3959_055_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	055	0	1	01	01	H3959_055_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	055	0	1	01	01	H3959_055_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	055	0	1	01	01	H3959_055_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	055	0	1	01	01	H3959_055_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	055	0	1	01	01	H3959_055_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3959	055	0	1	01	01	H3959_055_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											580.08	30						444.43	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H3962	001	0	1	01	01	H3962_001_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	10.50	14.00					0.00	0.00	0.00											7.00	10.50	14.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	5		Y	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	10.50	14.00					0.00	0.00	0.00											7.00	10.50	14.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3962	001	0	1	01	01	H3962_001_0	5		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								8.00	12.00	16.00					0.00	0.00	0.00											8.00	12.00	16.00				0.00	0.00	0.00					8.00			8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	5		Y	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								8.00	12.00	16.00					0.00	0.00	0.00											8.00	12.00	16.00				0.00	0.00	0.00					8.00			8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3962	001	0	1	01	01	H3962_001_0	5		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	70.50	94.00					40.00	60.00	80.00											47.00	70.50	94.00				40.00	60.00	80.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	150.00	200.00					93.00	139.50	186.00											100.00	150.00	200.00				93.00	139.50	186.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1006.80	33						1006.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	10.50	14.00					0.00	0.00	0.00											7.00	10.50	14.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	001	0	1	01	01	H3962_001_0	5		Y	Select Care Drugs	4	01	1	2	6	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	10.50	14.00					0.00	0.00	0.00											7.00	10.50	14.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3962	004	0	1	01	01	H3962_004_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	5		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	5		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	279.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											966.65	33						966.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	004	0	1	01	01	H3962_004_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	5		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	5		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	279.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											819.22	33						819.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3962	007	0	1	01	01	H3962_007_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3975	001	0	1	04	01	H3975_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3975	001	0	1	04	01	H3975_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3975	001	0	1	04	01	H3975_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3975	001	0	1	04	01	H3975_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.01	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3975	001	0	1	04	01	H3975_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	5		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3979	001	0	1	01	01	H3979_001_0	5		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	5		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	12		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	12		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	009	0	1	01	01	H4003_009_0	12		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	12		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	009	0	1	01	01	H4003_009_0	12		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	12		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	25.00		50.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	12		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				282.99	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	11		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	11		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
H4003	019	0	1	02	01	H4003_019_0	11		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	11		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	019	0	1	02	01	H4003_019_0	11		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	8.00		16.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	11		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	02	01	H4003_019_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				303.52	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	12		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	12		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
H4003	034	0	1	02	01	H4003_034_0	12		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	12		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	034	0	1	02	01	H4003_034_0	12		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	12		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	12		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				464.63	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	12		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	12		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	044	0	1	02	01	H4003_044_0	12		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	12		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		10.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	044	0	1	02	01	H4003_044_0	12		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	30.00		60.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	12		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	50.00		100.00																					100.00																50.00				50.00		1.67						1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	044	0	1	02	01	H4003_044_0	12		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				281.74	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	051	0	1	02	01	H4003_051_0	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	051	0	1	02	01	H4003_051_0	9		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	051	0	1	02	01	H4003_051_0	9		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	051	0	1	02	01	H4003_051_0	9		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	051	0	1	02	01	H4003_051_0	9		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	051	0	1	02	01	H4003_051_0	9		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	16.00		32.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	051	0	1	02	01	H4003_051_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				374.46	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	14		Y	Preferred Generic	4	01	3	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	14		Y	Preferred Generic	4	01	3	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		1
H4004	056	0	1	02	01	H4004_056_0	14		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	14		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4004	056	0	1	02	01	H4004_056_0	14		Y	Preferred Brand	4	10	3	2	3	1	110		01	100		1	30		90				2	2			90				30		31	8.00		16.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	14		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	12.00		24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	02	01	H4004_056_0	14		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				147.98	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	10		Y	Preferred Generic	4	01	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10		Y	Preferred Generic	4	01	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H4005	004	0	1	04	01	H4005_004_0	10		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H4005	004	0	1	04	01	H4005_004_0	10		Y	Preferred Brand	4	10	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								40.00		80.00					25.00		50.00							50.00																40.00				25.00			1.33	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					40.00		80.00							80.00																55.00				40.00			1.83	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4005	004	0	1	04	01	H4005_004_0	10		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4007	012	0	1	01	01	H4007_012_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	012	0	1	01	01	H4007_012_0	6		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	013	0	1	01	01	H4007_013_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	013	0	1	01	01	H4007_013_0	6		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	013	0	1	01	01	H4007_013_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	013	0	1	01	01	H4007_013_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	013	0	1	01	01	H4007_013_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	013	0	1	01	01	H4007_013_0	6		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	2		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	2		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	2		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	28.00		84.00																									28.00		84.00				28.00		74.00				28.00				28.00		0.93				0.93	0.93	0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	58.00		174.00																									58.00		174.00				58.00		164.00				58.00				58.00		1.93				1.93	1.93	1.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	2		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	020	0	1	01	01	H4007_020_0	2		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0				0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									6.67		15.00				6.67		10.00				5.00				5.00		0.17				0.22	0.22	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4007	021	0	1	01	01	H4007_021_0	5		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	009	0	1	04	01	H4036_009_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	010	1	1	04	01	H4036_010_1	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	010	2	1	04	01	H4036_010_2	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	017	0	1	04	01	H4036_017_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	017	0	1	04	01	H4036_017_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4036	020	0	1	04	01	H4036_020_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	020	0	1	04	01	H4036_020_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4091	003	0	1	04	01	H4091_003_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	4.00	8.00	12.00																			4.00	8.00	12.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4091	003	0	1	04	01	H4091_003_0	5		Y	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	15.00	30.00	45.00																			15.00	30.00	45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4091	003	0	1	04	01	H4091_003_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	45.00	90.00	135.00																			45.00	90.00	135.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4091	003	0	1	04	01	H4091_003_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	95.00	190.00	285.00																			95.00	190.00	285.00																	95.00			95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4091	003	0	1	04	01	H4091_003_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31					30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4140	001	0	1	02	01	H4140_001_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4140	001	0	1	02	01	H4140_001_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	001	0	1	02	01	H4140_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				419.41	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	002	0	1	02	01	H4140_002_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	002	0	1	02	01	H4140_002_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4140	002	0	1	02	01	H4140_002_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	002	0	1	02	01	H4140_002_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4140	002	0	1	02	01	H4140_002_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	002	0	1	02	01	H4140_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	35.00	70.00	105.00																			35.00	70.00	105.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	002	0	1	02	01	H4140_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				711.52	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	003	0	1	02	01	H4140_003_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	003	0	1	02	01	H4140_003_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4140	003	0	1	02	01	H4140_003_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	003	0	1	02	01	H4140_003_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4140	003	0	1	02	01	H4140_003_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	003	0	1	02	01	H4140_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	003	0	1	02	01	H4140_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				857.31	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	004	0	1	02	01	H4140_004_0	6		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	004	0	1	02	01	H4140_004_0	6		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4140	004	0	1	02	01	H4140_004_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	004	0	1	02	01	H4140_004_0	6		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4140	004	0	1	02	01	H4140_004_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	004	0	1	02	01	H4140_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	004	0	1	02	01	H4140_004_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				739.35	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	005	0	1	02	01	H4140_005_0	8		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	005	0	1	02	01	H4140_005_0	8		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4140	005	0	1	02	01	H4140_005_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	005	0	1	02	01	H4140_005_0	8		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4140	005	0	1	02	01	H4140_005_0	8		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	005	0	1	02	01	H4140_005_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	005	0	1	02	01	H4140_005_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				833.48	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	006	0	1	02	01	H4140_006_0	7		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	006	0	1	02	01	H4140_006_0	7		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4140	006	0	1	02	01	H4140_006_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	006	0	1	02	01	H4140_006_0	7		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4140	006	0	1	02	01	H4140_006_0	7		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				112.63	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	006	0	1	02	01	H4140_006_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				79.11	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	006	0	1	02	01	H4140_006_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				579.86	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	007	0	1	02	01	H4140_007_0	8		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	007	0	1	02	01	H4140_007_0	8		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4140	007	0	1	02	01	H4140_007_0	8		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	007	0	1	02	01	H4140_007_0	8		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4140	007	0	1	02	01	H4140_007_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				112.63	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	007	0	1	02	01	H4140_007_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				79.11	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4140	007	0	1	02	01	H4140_007_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				579.86	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	6		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	6		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	6		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	3	1	01	01	H4141_017_3	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	4	1	01	01	H4141_017_4	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	017	5	1	01	01	H4141_017_5	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	12		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	12		Y	Preferred Generic	4	01	1	2	1	3		111	01	101		1				30	60	90	1	2		60	90				30		31								11.00	22.00	33.00					3.00	6.00	9.00						0.00	0.00																11.00				3.00			0.37	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	12		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	12		Y	Generic	4	01	1	2	2	3		111	01	101		1				30	60	90	1	2		60	90				30		31								14.00	28.00	42.00					6.00	12.00	18.00						0.00	0.00																14.00				6.00			0.47	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	12		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	12		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	12		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								9.00	18.00	27.00					1.00	2.00	3.00						0.00	0.00																9.00				1.00			0.30	0.03				0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								16.00	32.00	48.00					8.00	16.00	24.00						0.00	0.00																16.00				8.00			0.53	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								10.00	20.00	30.00					2.00	4.00	6.00						0.00	0.00																10.00				2.00			0.33	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								17.00	34.00	51.00					9.00	18.00	27.00						0.00	0.00																17.00				9.00			0.57	0.30				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00						0.00	0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								12.00	24.00	36.00					4.00	8.00	12.00						0.00	0.00																12.00				4.00			0.40	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	11		Y	Preferred Generic	4	01	1	2	1	1		111	01	101		1				30	60	90	1	2		60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00						0.00	0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	11		Y	Generic	4	01	1	2	2	1		111	01	101		1				30	60	90	1	2		60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00						0.00	0.00																16.00				0.00			0.53	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	01	101		1				30	60	90	1	2		60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00						94.00	117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	101		1				30	60	90	1	2		60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00						200.00	250.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4152	020	0	1	02	01	H4152_020_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	4		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	4		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4172	002	0	1	01	01	H4172_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				2200.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	5		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				1373.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			13.00	26.00	26.00																13.00				13.00		.43			.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	4		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1261.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8			Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		100	1	2	30		100				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8			Generic	3	01	1	2	2	1		110	01	110		1				30		100	1	2	30		100				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8			Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		100	1	2	30		100				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8			Non-Preferred Drug	3	11	1	1	4	1		110	01	110		1				30		100	1	2	30		100				30		31											98.33	42		42				90.02	40		40				40		40															42			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	8			Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		100	1	2	30		100				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7			Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		100	1	2	30		100				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7			Generic	3	01	1	2	2	1		110	01	110		1				30		100	1	2	30		100				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7			Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		100	1	2	30		100				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7			Non-Preferred Drug	3	11	1	1	4	1		110	01	110		1				30		100	1	2	30		100				30		31											98.33	42		42				90.02	40		40				40		40															42			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	7			Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		100	1	2	30		100				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	7			Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		100	1	2	30		100				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	7			Generic	3	01	1	2	2	1		110	01	110		1				30		100	1	2	30		100				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	7			Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		100	1	2	30		100				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	7			Non-Preferred Drug	3	11	1	1	4	1		110	01	110		1				30		100	1	2	30		100				30		31											98.33	42		42				90.02	40		40				40		40															42			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	7			Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		100	1	2	30		100				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	6		N	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Brand												
H4227	001	0	1	01	01	H4227_001_0	6		N	Brand	2	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				92.28	25	25	25																				25															25			25								Generic, Brand												
H4227	002	0	1	01	01	H4227_002_0	6		N	Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Brand												
H4227	002	0	1	01	01	H4227_002_0	6		N	Brand	2	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				90.79	25	25	25																				25															25			25								Generic, Brand												
H4279	001	0	1	01	01	H4279_001_0	9		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		10.00							10.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	9		N	Generic	2	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	9		N	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								38.00		114.00					18.00		45.00							45.00																38.00				38.00			1.27	0.60				1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	9		N	Non-Preferred Drug	2	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											60.20	49		49				59.46	49		49						49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	9		N	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31											529.57	25						498.45	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	8		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		10.00							10.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	8		N	Generic	2	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	8		N	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								38.00		114.00					18.00		45.00							45.00																38.00				38.00			1.27	0.60				1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	8		N	Non-Preferred Drug	2	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											61.16	49		49				60.02	49		49						49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4279	004	0	1	01	01	H4279_004_0	8		N	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31											535.75	25						503.69	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4304	001	0	1	04	01	H4304_001_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	0.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4304	001	0	1	04	01	H4304_001_0	6		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4304	001	0	1	04	01	H4304_001_0	6		Y	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4304	001	0	1	04	01	H4304_001_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4304	001	0	1	04	01	H4304_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1483.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4343	001	0	1	01	01	H4343_001_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	001	0	1	01	01	H4343_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	002	0	1	01	01	H4343_002_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	003	0	1	01	01	H4343_003_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4343	004	0	1	01	01	H4343_004_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	005	0	1	01	01	H4346_005_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	006	0	1	01	01	H4346_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	008	0	1	01	01	H4346_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			.42	.25	0.25			.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	009	0	1	01	01	H4346_009_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.50	31.00	46.50					10.50	21.00	31.50					10.50	21.00	21.00																15.50				15.50			0.52	0.35	0.35			.46	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	180.00	180.00																95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	20.00	20.00																10.00				10.00			0.33	0.33	0.33			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	010	0	1	01	01	H4346_010_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	010	0	1	01	01	H4346_010_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	011	0	1	01	01	H4346_011_0	6		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34				1.27	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	011	0	1	01	01	H4346_011_0	6		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				5.18	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	011	0	1	01	01	H4346_011_0	6		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				69.09	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	011	0	1	01	01	H4346_011_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				65.57	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	011	0	1	01	01	H4346_011_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	011	0	1	01	01	H4346_011_0	6		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	011	0	1	01	01	H4346_011_0	6		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	012	0	1	01	01	H4346_012_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	012	0	1	01	01	H4346_012_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	013	0	1	01	01	H4346_013_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	013	0	1	01	01	H4346_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	013	0	1	01	01	H4346_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	013	0	1	01	01	H4346_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	013	0	1	01	01	H4346_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	013	0	1	01	01	H4346_013_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	013	0	1	01	01	H4346_013_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	014	0	1	01	01	H4346_014_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	014	0	1	01	01	H4346_014_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								36.00	72.00	108.00					36.00	72.00	108.00					36.00	108.00	108.00																36.00				36.00			1.20	1.20	1.20			1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	014	0	1	01	01	H4346_014_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	017	0	1	01	01	H4346_017_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4346	017	0	1	01	01	H4346_017_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	017	0	1	01	01	H4346_017_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4346	018	0	1	01	01	H4346_018_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	018	0	1	01	01	H4346_018_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4346	019	0	1	01	01	H4346_019_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	019	0	1	01	01	H4346_019_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	022	0	1	01	01	H4346_022_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	022	0	1	01	01	H4346_022_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	7		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	022	0	1	01	01	H4346_022_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	022	0	1	01	01	H4346_022_0	7		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	023	0	1	01	01	H4346_023_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	023	0	1	01	01	H4346_023_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	023	0	1	01	01	H4346_023_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	023	0	1	01	01	H4346_023_0	7		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	023	0	1	01	01	H4346_023_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	023	0	1	01	01	H4346_023_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	023	0	1	01	01	H4346_023_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	023	0	1	01	01	H4346_023_0	7		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	023	0	1	01	01	H4346_023_0	7		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4346	024	0	1	01	01	H4346_024_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	024	0	1	01	01	H4346_024_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4346	024	0	1	01	01	H4346_024_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	024	0	1	01	01	H4346_024_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	024	0	1	01	01	H4346_024_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	024	0	1	01	01	H4346_024_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4346	025	0	1	01	01	H4346_025_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	025	0	1	01	01	H4346_025_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4346	026	0	1	01	01	H4346_026_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	026	0	1	01	01	H4346_026_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	026	0	1	01	01	H4346_026_0	5		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				66.43	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				68.69	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	026	0	1	01	01	H4346_026_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4407	026	0	1	01	01	H4407_026_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	20.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	026	0	1	01	01	H4407_026_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.80	33						689.65	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	027	0	1	01	01	H4407_027_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											861.43	33						666.14	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	02	01	H4461_025_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	02	01	H4461_025_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	02	01	H4461_025_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	02	01	H4461_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	02	01	H4461_025_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	02	01	H4461_029_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	02	01	H4461_029_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	02	01	H4461_029_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	02	01	H4461_029_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	02	01	H4461_029_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	02	01	H4461_030_1	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	02	01	H4461_030_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	02	01	H4461_030_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	02	01	H4461_030_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	02	01	H4461_030_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	02	01	H4461_030_2	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	02	01	H4461_030_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	02	01	H4461_030_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	02	01	H4461_030_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	02	01	H4461_030_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	02	01	H4461_030_3	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	02	01	H4461_030_3	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	02	01	H4461_030_3	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	02	01	H4461_030_3	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	02	01	H4461_030_3	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	02	01	H4461_031_1	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	02	01	H4461_031_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	02	01	H4461_031_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	02	01	H4461_031_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	02	01	H4461_031_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	02	01	H4461_031_2	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	02	01	H4461_031_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	02	01	H4461_031_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	02	01	H4461_031_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	02	01	H4461_031_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	02	01	H4461_031_3	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	02	01	H4461_031_3	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	02	01	H4461_031_3	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	02	01	H4461_031_3	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	02	01	H4461_031_3	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	02	01	H4461_034_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	02	01	H4461_034_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	02	01	H4461_034_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	02	01	H4461_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	034	0	1	02	01	H4461_034_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	02	01	H4461_035_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	02	01	H4461_035_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	02	01	H4461_035_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	02	01	H4461_035_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	035	0	1	02	01	H4461_035_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	02	01	H4461_036_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	02	01	H4461_036_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	02	01	H4461_036_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	02	01	H4461_036_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	036	0	1	02	01	H4461_036_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	02	01	H4461_037_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	02	01	H4461_037_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	02	01	H4461_037_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	02	01	H4461_037_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	037	0	1	02	01	H4461_037_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	4		N	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								14	31	0.00	0.00	0.00																																						0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	4		N	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								14	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	4		N	Preferred Brand	4	11	1	2	3	1	111		10			1	30	60	90				1	2								14	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		10			1	30	60	90				1	2								14	31	98.00	196.00	294.00																																						98.00			98.00		3.27						3.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4490	002	0	1	01	01	H4490_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		10			1	30															14	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	11		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	11		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	11		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	11		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	11		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	11		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											78.74	50		50				81.10	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	12		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	12		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	12		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	12		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	12		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	12		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											78.74	50		50				81.10	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	12		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	3	1	04	01	H4497_001_3	11		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	3	1	04	01	H4497_001_3	11		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	3	1	04	01	H4497_001_3	11		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	3	1	04	01	H4497_001_3	11		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	3	1	04	01	H4497_001_3	11		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	3	1	04	01	H4497_001_3	11		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											78.74	50		50				81.10	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	3	1	04	01	H4497_001_3	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	1	1	04	01	H4497_002_1	11		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	1	1	04	01	H4497_002_1	11		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											81.73	50		50				78.51	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	2	1	04	01	H4497_002_2	11		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	2	1	04	01	H4497_002_2	11		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											81.73	50		50				78.51	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	11		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	11		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	3	1	04	01	H4497_002_3	11		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	11		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	3	1	04	01	H4497_002_3	11		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	11		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											81.73	50		50				78.51	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	3	1	04	01	H4497_002_3	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	11		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	11		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_003_1	11		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	11		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_003_1	11		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	11		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											81.60	50		50				80.04	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	11		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	11		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	2	1	04	01	H4497_003_2	11		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	11		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	2	1	04	01	H4497_003_2	11		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	11		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											81.60	50		50				80.04	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	12		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	12		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	3	1	04	01	H4497_003_3	12		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	12		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	3	1	04	01	H4497_003_3	12		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	12		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											81.60	50		50				80.04	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	3	1	04	01	H4497_003_3	12		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4506	003	0	1	01	01	H4506_003_0	6		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	6		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	80.00		240.00																									80.00		240.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4506	029	0	1	02	01	H4506_029_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				68.96	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	026	0	1	01	01	H4513_026_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	026	0	1	01	01	H4513_026_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											662.13	29						466.62	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	028	0	1	01	01	H4513_028_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	028	0	1	01	01	H4513_028_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											678.06	29						514.94	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	030	0	1	01	01	H4513_030_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					12.00	24.00	24.00											20.00	40.00	40.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					12.00	24.00	24.00											20.00	40.00	40.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	030	0	1	01	01	H4513_030_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.53	38	38	38				85.75	38	38	38										38	38	38				38	38	38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	030	0	1	01	01	H4513_030_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											620.73	29						491.54	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	036	0	1	02	01	H4513_036_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	036	0	1	02	01	H4513_036_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.94	40	40	40				87.38	40	40	40										40	40	40				40	40	40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	036	0	1	02	01	H4513_036_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											710.21	29						561.80	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					0.00	0.00	0.00											10.00	20.00	20.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					0.00	0.00	0.00											10.00	20.00	20.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	037	0	1	01	01	H4513_037_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	037	0	1	01	01	H4513_037_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.14	43	43	43				81.45	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	037	0	1	01	01	H4513_037_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											833.34	33						750.74	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	038	0	1	01	01	H4513_038_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	038	0	1	01	01	H4513_038_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											85.82	50	50	50				79.11	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	038	0	1	01	01	H4513_038_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											781.21	33						659.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	042	0	1	01	01	H4513_042_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	042	0	1	01	01	H4513_042_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4513	042	0	1	01	01	H4513_042_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	042	0	1	01	01	H4513_042_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	042	0	1	01	01	H4513_042_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	042	0	1	01	01	H4513_042_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.44	49	49	49				79.65	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	042	0	1	01	01	H4513_042_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											869.97	33						662.19	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	043	0	1	01	01	H4513_043_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	043	0	1	01	01	H4513_043_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	043	0	1	01	01	H4513_043_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	043	0	1	01	01	H4513_043_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	043	0	1	01	01	H4513_043_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	043	0	1	01	01	H4513_043_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											85.06	50	50	50				74.90	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	043	0	1	01	01	H4513_043_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											927.47	33						703.09	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	4.00											9.00	18.00	27.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	16.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.68	39	39	39				85.82	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	1	1	01	01	H4513_046_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											619.69	29						572.48	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					2.00	4.00	4.00											9.00	18.00	27.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					8.00	16.00	16.00											15.00	30.00	45.00				8.00	16.00	0.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.68	39	39	39				85.82	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	046	2	1	01	01	H4513_046_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											619.69	29						572.48	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	047	0	1	01	01	H4513_047_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											652.71	33						667.38	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	048	0	1	01	01	H4513_048_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.30	33						618.13	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	049	1	1	01	01	H4513_049_1	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	049	1	1	01	01	H4513_049_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.18	50	50	50				83.85	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	1	1	01	01	H4513_049_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											854.89	33						709.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	049	2	1	01	01	H4513_049_2	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	24.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	049	2	1	01	01	H4513_049_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.18	50	50	50				83.85	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	049	2	1	01	01	H4513_049_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											854.89	33						709.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	050	0	1	01	01	H4513_050_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	050	0	1	01	01	H4513_050_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.73	50	50	50				83.86	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	050	0	1	01	01	H4513_050_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											852.38	33						709.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	051	0	1	01	01	H4513_051_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	051	0	1	01	01	H4513_051_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.73	50	50	50				83.86	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	051	0	1	01	01	H4513_051_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											852.38	33						709.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	6.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	052	0	1	01	01	H4513_052_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	052	0	1	01	01	H4513_052_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.73	50	50	50				83.86	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	052	0	1	01	01	H4513_052_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											852.38	33						709.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	16.00											13.00	26.00	39.00				8.00	16.00	0.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	054	0	1	01	01	H4513_054_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											925.47	33						631.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	16.00											13.00	26.00	39.00				8.00	16.00	0.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	057	0	1	01	01	H4513_057_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											699.17	33						708.44	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					0.00	0.00	0.00											10.00	20.00	20.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					0.00	0.00	0.00											10.00	20.00	20.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	059	0	1	01	01	H4513_059_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	059	0	1	01	01	H4513_059_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.77	49	49	49				82.81	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	059	0	1	01	01	H4513_059_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											854.11	33						712.85	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	061	1	1	01	01	H4513_061_1	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	1	1	01	01	H4513_061_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											699.74	29						526.51	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	061	2	1	01	01	H4513_061_2	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	2	1	01	01	H4513_061_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											699.74	29						526.51	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	7		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	061	3	1	01	01	H4513_061_3	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	061	3	1	01	01	H4513_061_3	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											699.74	29						526.51	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4514	007	0	1	01	01	H4514_007_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				293.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	001	0	1	01	01	H4523_001_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	001	0	1	01	01	H4523_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	001	0	1	01	01	H4523_001_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	001	0	1	01	01	H4523_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	001	0	1	01	01	H4523_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	001	0	1	01	01	H4523_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											628.80	28						404.87	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	015	0	1	01	01	H4523_015_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	015	0	1	01	01	H4523_015_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	015	0	1	01	01	H4523_015_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	015	0	1	01	01	H4523_015_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	015	0	1	01	01	H4523_015_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	015	0	1	01	01	H4523_015_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	015	0	1	01	01	H4523_015_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											831.04	28						445.51	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	020	0	1	01	01	H4523_020_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	020	0	1	01	01	H4523_020_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	020	0	1	01	01	H4523_020_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	020	0	1	01	01	H4523_020_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	020	0	1	01	01	H4523_020_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	020	0	1	01	01	H4523_020_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	020	0	1	01	01	H4523_020_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											661.00	28						490.95	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	021	0	1	01	01	H4523_021_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	021	0	1	01	01	H4523_021_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	021	0	1	01	01	H4523_021_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	021	0	1	01	01	H4523_021_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	021	0	1	01	01	H4523_021_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	021	0	1	01	01	H4523_021_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	021	0	1	01	01	H4523_021_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											718.64	28						359.50	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	024	0	1	01	01	H4523_024_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	024	0	1	01	01	H4523_024_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	024	0	1	01	01	H4523_024_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	024	0	1	01	01	H4523_024_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	024	0	1	01	01	H4523_024_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	024	0	1	01	01	H4523_024_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4523	024	0	1	01	01	H4523_024_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											752.84	28						471.67	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4527	001	0	1	01	01	H4527_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4527	001	0	1	01	01	H4527_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				428.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4527	002	0	1	01	01	H4527_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				376.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4527	005	0	1	01	01	H4527_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				400.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4527	013	0	1	01	01	H4527_013_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				293.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4527	037	0	1	02	01	H4527_037_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	02	01	H4527_037_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				336.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	01	01	H4527_039_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	01	01	H4527_039_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	039	0	1	01	01	H4527_039_0	6		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	01	01	H4527_039_0	6		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	039	0	1	01	01	H4527_039_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	01	01	H4527_039_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	039	0	1	01	01	H4527_039_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				306.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	01	01	H4527_040_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	01	01	H4527_040_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	040	0	1	01	01	H4527_040_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	01	01	H4527_040_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	040	0	1	01	01	H4527_040_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	01	01	H4527_040_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	040	0	1	01	01	H4527_040_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				365.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	01	01	H4527_041_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	01	01	H4527_041_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	041	0	1	01	01	H4527_041_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	01	01	H4527_041_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	041	0	1	01	01	H4527_041_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	01	01	H4527_041_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	041	0	1	01	01	H4527_041_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				346.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	01	01	H4527_042_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	01	01	H4527_042_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4527	042	0	1	01	01	H4527_042_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	01	01	H4527_042_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4527	042	0	1	01	01	H4527_042_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	01	01	H4527_042_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	042	0	1	01	01	H4527_042_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				362.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4544	001	0	1	04	01	H4544_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4544	001	0	1	04	01	H4544_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						135.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4544	001	0	1	04	01	H4544_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				245.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	010	0	1	01	01	H4590_010_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	010	0	1	01	01	H4590_010_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				399.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						14.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						14.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4590	012	0	1	02	01	H4590_012_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	02	01	H4590_012_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				341.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4590	025	0	1	01	01	H4590_025_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				273.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	037	0	1	01	01	H4590_037_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4590	037	0	1	01	01	H4590_037_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				307.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4590	041	0	1	02	01	H4590_041_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	02	01	H4590_041_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				509.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4590	042	0	1	02	01	H4590_042_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	042	0	1	02	01	H4590_042_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				233.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4590	043	0	1	02	01	H4590_043_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	043	0	1	02	01	H4590_043_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				345.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	4		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	044	0	1	02	01	H4590_044_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4590	044	0	1	02	01	H4590_044_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	044	0	1	02	01	H4590_044_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				307.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	003	0	1	01	01	H4604_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				316.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	011	0	1	01	01	H4604_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				361.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	01	01	H4604_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	01	01	H4604_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	01	01	H4604_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	012	0	1	01	01	H4604_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	01	01	H4604_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	012	0	1	01	01	H4604_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				324.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	01	01	H4604_013_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	01	01	H4604_013_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	01	01	H4604_013_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	013	0	1	01	01	H4604_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	01	01	H4604_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	013	0	1	01	01	H4604_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				145.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	01	01	H4604_014_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	01	01	H4604_014_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	01	01	H4604_014_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	014	0	1	01	01	H4604_014_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	01	01	H4604_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	014	0	1	01	01	H4604_014_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				207.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	01	01	H4604_015_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	01	01	H4604_015_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	01	01	H4604_015_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	015	0	1	01	01	H4604_015_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	01	01	H4604_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	015	0	1	01	01	H4604_015_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				317.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	01	01	H4604_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	01	01	H4604_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	01	01	H4604_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	016	0	1	01	01	H4604_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	01	01	H4604_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	016	0	1	01	01	H4604_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				360.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	01	01	H4604_017_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	01	01	H4604_017_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	01	01	H4604_017_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	017	0	1	01	01	H4604_017_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	01	01	H4604_017_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	017	0	1	01	01	H4604_017_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				274.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	01	01	H4604_018_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	01	01	H4604_018_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	01	01	H4604_018_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	018	0	1	01	01	H4604_018_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	01	01	H4604_018_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	018	0	1	01	01	H4604_018_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											353.00	29						289.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	01	01	H4604_020_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	01	01	H4604_020_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	01	01	H4604_020_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4604	020	0	1	01	01	H4604_020_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	01	01	H4604_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	020	0	1	01	01	H4604_020_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				279.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											852.48	30						852.48	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	004	0	1	04	01	H4605_004_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											937.73	33						937.73	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	007	0	1	04	01	H4605_007_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	008	0	1	04	01	H4605_008_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	008	0	1	04	01	H4605_008_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	008	0	1	04	01	H4605_008_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	008	0	1	04	01	H4605_008_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	008	0	1	04	01	H4605_008_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	009	0	1	04	01	H4605_009_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	009	0	1	04	01	H4605_009_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	009	0	1	04	01	H4605_009_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	009	0	1	04	01	H4605_009_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	009	0	1	04	01	H4605_009_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											852.48	30						852.48	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	001	0	1	01	01	H4623_001_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	01	01	H4623_002_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	01	01	H4623_002_0	4		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	01	01	H4623_002_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	01	01	H4623_002_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4623	002	0	1	01	01	H4623_002_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4624	001	0	1	01	01	H4624_001_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	001	0	1	01	01	H4624_001_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	001	0	1	01	01	H4624_001_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	001	0	1	01	01	H4624_001_0	8		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	001	0	1	01	01	H4624_001_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	001	0	1	01	01	H4624_001_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	001	0	1	01	01	H4624_001_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	001	0	1	01	01	H4624_001_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	001	0	1	01	01	H4624_001_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	002	0	1	02	01	H4624_002_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	002	0	1	02	01	H4624_002_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	002	0	1	02	01	H4624_002_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	002	0	1	02	01	H4624_002_0	8		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	002	0	1	02	01	H4624_002_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	002	0	1	02	01	H4624_002_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	002	0	1	02	01	H4624_002_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	002	0	1	02	01	H4624_002_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	002	0	1	02	01	H4624_002_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	003	0	1	01	01	H4624_003_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	003	0	1	01	01	H4624_003_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	003	0	1	01	01	H4624_003_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	003	0	1	01	01	H4624_003_0	8		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	003	0	1	01	01	H4624_003_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	003	0	1	01	01	H4624_003_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	003	0	1	01	01	H4624_003_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	003	0	1	01	01	H4624_003_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	003	0	1	01	01	H4624_003_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	004	0	1	01	01	H4624_004_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	004	0	1	01	01	H4624_004_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	004	0	1	01	01	H4624_004_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	004	0	1	01	01	H4624_004_0	8		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	004	0	1	01	01	H4624_004_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	004	0	1	01	01	H4624_004_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	004	0	1	01	01	H4624_004_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	004	0	1	01	01	H4624_004_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	004	0	1	01	01	H4624_004_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	005	0	1	01	01	H4624_005_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	005	0	1	01	01	H4624_005_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	005	0	1	01	01	H4624_005_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	005	0	1	01	01	H4624_005_0	8		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	005	0	1	01	01	H4624_005_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	005	0	1	01	01	H4624_005_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	005	0	1	01	01	H4624_005_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	005	0	1	01	01	H4624_005_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	005	0	1	01	01	H4624_005_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	006	0	1	01	01	H4624_006_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	006	0	1	01	01	H4624_006_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	006	0	1	01	01	H4624_006_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	006	0	1	01	01	H4624_006_0	8		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	006	0	1	01	01	H4624_006_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	006	0	1	01	01	H4624_006_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	006	0	1	01	01	H4624_006_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	006	0	1	01	01	H4624_006_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	006	0	1	01	01	H4624_006_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	007	0	1	02	01	H4624_007_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	007	0	1	02	01	H4624_007_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	007	0	1	02	01	H4624_007_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	007	0	1	02	01	H4624_007_0	8		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	007	0	1	02	01	H4624_007_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	007	0	1	02	01	H4624_007_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	007	0	1	02	01	H4624_007_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	007	0	1	02	01	H4624_007_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	007	0	1	02	01	H4624_007_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	010	0	1	01	01	H4624_010_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	010	0	1	01	01	H4624_010_0	8		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	010	0	1	01	01	H4624_010_0	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	010	0	1	01	01	H4624_010_0	8		Y	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	010	0	1	01	01	H4624_010_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	010	0	1	01	01	H4624_010_0	8		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	010	0	1	01	01	H4624_010_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	010	0	1	01	01	H4624_010_0	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	010	0	1	01	01	H4624_010_0	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	011	0	1	01	01	H4624_011_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	011	0	1	01	01	H4624_011_0	8		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	011	0	1	01	01	H4624_011_0	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	011	0	1	01	01	H4624_011_0	8		Y	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	011	0	1	01	01	H4624_011_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	011	0	1	01	01	H4624_011_0	8		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	011	0	1	01	01	H4624_011_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	011	0	1	01	01	H4624_011_0	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	011	0	1	01	01	H4624_011_0	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	012	0	1	01	01	H4624_012_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	012	0	1	01	01	H4624_012_0	8		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	012	0	1	01	01	H4624_012_0	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	012	0	1	01	01	H4624_012_0	8		Y	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4624	012	0	1	01	01	H4624_012_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	012	0	1	01	01	H4624_012_0	8		Y	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	012	0	1	01	01	H4624_012_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	012	0	1	01	01	H4624_012_0	8		Y	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H4624	012	0	1	01	01	H4624_012_0	8		Y	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H4675	001	0	1	01	01	H4675_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4675	001	0	1	01	01	H4675_001_0	7		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			5.00	10.00	15.00																10.00				10.00		0.33			0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4675	001	0	1	01	01	H4675_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4675	001	0	1	01	01	H4675_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4675	001	0	1	01	01	H4675_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				755.00	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4676	001	0	1	01	01	H4676_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01			1				30	60	90	2	1							30		31								10.00	20.00	30.00					0.00	0.00	0.00																							10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	001	0	1	01	01	H4676_001_0	4		N	Generic	4	01	1	2	2	1		111	01			1				30	60	90	2	1							30		31								20.00	40.00	60.00					5.00	10.00	15.00																							20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	001	0	1	01	01	H4676_001_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01			1				30	60	90	2	1							30		31								40.00	80.00	120.00					25.00	50.00	75.00																							40.00				40.00			1.33	0.83				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	001	0	1	01	01	H4676_001_0	4		N	Non-Preferred Brand	4	10	1	2	4	1		111	01			1				30	60	90	2	1							30		31								100.00	200.00	300.00					100.00	200.00	300.00																							100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	001	0	1	01	01	H4676_001_0	4		N	Specialty Tier	4	10	1	1	5	1		111	01			1				30	60	90	2	1							30		31											929.28	33	33	33				929.28	33	33	33																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	002	0	1	01	01	H4676_002_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01			1	30	60	90				2	2							30		31	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	002	0	1	01	01	H4676_002_0	4		N	Generic	4	11	1	1	2	1	111		01			1	30	60	90				2	2							30		31				11.66	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	002	0	1	01	01	H4676_002_0	4		N	Preferred Brand	4	11	1	1	3	1	111		01			1	30	60	90				2	2							30		31				117.71	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	002	0	1	01	01	H4676_002_0	4		N	Non-Preferred Brand	4	11	1	1	4	1	111		01			1	30	60	90				2	2							30		31				81.46	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4676	002	0	1	01	01	H4676_002_0	4		N	Specialty Tier	4	11	1	1	5	1	111		01			1	30	60	90				2	2							30		31				706.61	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4699	001	0	1	04	01	H4699_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	001	0	1	04	01	H4699_001_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4699	001	0	1	04	01	H4699_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	001	0	1	04	01	H4699_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	001	0	1	04	01	H4699_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.91	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	001	0	1	04	01	H4699_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	002	0	1	04	01	H4699_002_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	002	0	1	04	01	H4699_002_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4699	002	0	1	04	01	H4699_002_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	002	0	1	04	01	H4699_002_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	002	0	1	04	01	H4699_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				75.84	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	002	0	1	04	01	H4699_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	003	0	1	04	01	H4699_003_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	003	0	1	04	01	H4699_003_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	003	0	1	04	01	H4699_003_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	003	0	1	04	01	H4699_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.62	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4699	003	0	1	04	01	H4699_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4709	001	0	1	01	01	H4709_001_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				758.71	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	001	0	1	01	01	H4709_001_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4709	003	0	1	01	01	H4709_003_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	003	0	1	01	01	H4709_003_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		10.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	003	0	1	01	01	H4709_003_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	003	0	1	01	01	H4709_003_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	003	0	1	01	01	H4709_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				755.66	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	003	0	1	01	01	H4709_003_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	003	0	1	01	01	H4709_003_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4709	011	0	1	01	01	H4709_011_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	011	0	1	01	01	H4709_011_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	4.00		8.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	011	0	1	01	01	H4709_011_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	011	0	1	01	01	H4709_011_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	011	0	1	01	01	H4709_011_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				603.57	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	011	0	1	01	01	H4709_011_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	011	0	1	01	01	H4709_011_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4709	024	0	1	01	01	H4709_024_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	024	0	1	01	01	H4709_024_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	4.00		8.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	024	0	1	01	01	H4709_024_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	024	0	1	01	01	H4709_024_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	024	0	1	01	01	H4709_024_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				616.01	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	024	0	1	01	01	H4709_024_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	024	0	1	01	01	H4709_024_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4709	025	0	1	01	01	H4709_025_0	4		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	4		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	4.00		8.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				615.63	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	4		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4709	025	0	1	01	01	H4709_025_0	4		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4711	001	0	1	01	01	H4711_001_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	001	0	1	01	01	H4711_001_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	001	0	1	01	01	H4711_001_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	001	0	1	01	01	H4711_001_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	001	0	1	01	01	H4711_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	001	0	1	01	01	H4711_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	001	0	1	01	01	H4711_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											764.55	33						557.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	002	0	1	01	01	H4711_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	002	0	1	01	01	H4711_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	002	0	1	01	01	H4711_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	002	0	1	01	01	H4711_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	002	0	1	01	01	H4711_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	002	0	1	01	01	H4711_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	002	0	1	01	01	H4711_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											760.07	33						554.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	005	0	1	01	01	H4711_005_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	005	0	1	01	01	H4711_005_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	005	0	1	01	01	H4711_005_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	005	0	1	01	01	H4711_005_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	005	0	1	01	01	H4711_005_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	005	0	1	01	01	H4711_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	005	0	1	01	01	H4711_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											746.72	33						544.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	006	0	1	01	01	H4711_006_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	006	0	1	01	01	H4711_006_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	006	0	1	01	01	H4711_006_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	006	0	1	01	01	H4711_006_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	006	0	1	01	01	H4711_006_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	006	0	1	01	01	H4711_006_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	006	0	1	01	01	H4711_006_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											792.89	33						576.86	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	007	0	1	01	01	H4711_007_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	007	0	1	01	01	H4711_007_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	007	0	1	01	01	H4711_007_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	007	0	1	01	01	H4711_007_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	007	0	1	01	01	H4711_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	007	0	1	01	01	H4711_007_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	007	0	1	01	01	H4711_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											786.81	33						572.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	008	0	1	01	01	H4711_008_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	008	0	1	01	01	H4711_008_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	008	0	1	01	01	H4711_008_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	008	0	1	01	01	H4711_008_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	008	0	1	01	01	H4711_008_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	008	0	1	01	01	H4711_008_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	008	0	1	01	01	H4711_008_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											781.09	33						568.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	009	0	1	01	01	H4711_009_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	009	0	1	01	01	H4711_009_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	009	0	1	01	01	H4711_009_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	009	0	1	01	01	H4711_009_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4711	009	0	1	01	01	H4711_009_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	009	0	1	01	01	H4711_009_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	009	0	1	01	01	H4711_009_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											797.00	33						579.12	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	011	0	1	01	01	H4711_011_0	3		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	011	0	1	01	01	H4711_011_0	3		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	011	0	1	01	01	H4711_011_0	3		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	011	0	1	01	01	H4711_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4711	011	0	1	01	01	H4711_011_0	3		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				480.94	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4754	004	0	1	04	01	H4754_004_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.67	33	33	33				96.62	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	007	0	1	04	01	H4754_007_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											85.83	33	33	33				87.05	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	009	0	1	04	01	H4754_009_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.38	33	33	33				90.42	31	31	31										33	33	33				31	31	31			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	011	0	1	04	01	H4754_011_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	3		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	3		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.21	32	32	32				96.34	31	31	31										32	32	32				31	31	31			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	017	0	1	04	01	H4754_017_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.10		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	36.00											17.00	34.00	51.00				12.00	24.00	24.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.76	32	32	32				88.94	31	31	31										32	32	32				31	31	31			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4		N	Select Care Drugs	4	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	017	0	1	04	01	H4754_017_0	4		N	Select Care Drugs	4	01	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4829	002	0	1	04	01	H4829_002_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	002	0	1	04	01	H4829_002_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	002	0	1	04	01	H4829_002_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	002	0	1	04	01	H4829_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	002	0	1	04	01	H4829_002_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	002	0	1	04	01	H4829_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				330.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	003	0	1	04	01	H4829_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	003	0	1	04	01	H4829_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				285.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						12.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H4829	004	0	1	04	01	H4829_004_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4829	004	0	1	04	01	H4829_004_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				294.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4835	001	0	1	01	01	H4835_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	001	0	1	01	01	H4835_001_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	001	0	1	01	01	H4835_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	001	0	1	01	01	H4835_001_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	001	0	1	01	01	H4835_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	001	0	1	01	01	H4835_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	001	0	1	01	01	H4835_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											775.79	33						568.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	002	0	1	01	01	H4835_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	002	0	1	01	01	H4835_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	002	0	1	01	01	H4835_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	002	0	1	01	01	H4835_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	002	0	1	01	01	H4835_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	002	0	1	01	01	H4835_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	002	0	1	01	01	H4835_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											774.41	33						567.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	003	0	1	01	01	H4835_003_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	003	0	1	01	01	H4835_003_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	003	0	1	01	01	H4835_003_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	003	0	1	01	01	H4835_003_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	003	0	1	01	01	H4835_003_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	003	0	1	01	01	H4835_003_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	003	0	1	01	01	H4835_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											755.62	33						555.34	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	004	0	1	01	01	H4835_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	004	0	1	01	01	H4835_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	004	0	1	01	01	H4835_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	004	0	1	01	01	H4835_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	004	0	1	01	01	H4835_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	004	0	1	01	01	H4835_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	004	0	1	01	01	H4835_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											787.24	33						576.34	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	005	0	1	01	01	H4835_005_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	005	0	1	01	01	H4835_005_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	005	0	1	01	01	H4835_005_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	005	0	1	01	01	H4835_005_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	005	0	1	01	01	H4835_005_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	005	0	1	01	01	H4835_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	005	0	1	01	01	H4835_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											729.41	30						535.73	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	006	0	1	01	01	H4835_006_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	006	0	1	01	01	H4835_006_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	006	0	1	01	01	H4835_006_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	006	0	1	01	01	H4835_006_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4835	006	0	1	01	01	H4835_006_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	006	0	1	01	01	H4835_006_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4835	006	0	1	01	01	H4835_006_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											636.76	28						462.99	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4847	001	0	1	01	01	H4847_001_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H4847	001	0	1	01	01	H4847_001_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	001	0	1	01	01	H4847_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_002_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_002_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H4847	002	0	1	01	01	H4847_002_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		180.00				90.00				90.00		3.00				3.00	3.00	2.9	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	002	0	1	01	01	H4847_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	003	0	1	01	01	H4847_003_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	003	0	1	01	01	H4847_003_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	003	0	1	01	01	H4847_003_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	003	0	1	01	01	H4847_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.19	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	003	0	1	01	01	H4847_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	004	0	1	01	01	H4847_004_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	004	0	1	01	01	H4847_004_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	004	0	1	01	01	H4847_004_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	004	0	1	01	01	H4847_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.11	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	004	0	1	01	01	H4847_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	005	0	1	01	01	H4847_005_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	005	0	1	01	01	H4847_005_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	005	0	1	01	01	H4847_005_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	005	0	1	01	01	H4847_005_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.89	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4847	005	0	1	01	01	H4847_005_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4853	001	0	1	01	01	H4853_001_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	001	0	1	01	01	H4853_001_0	6		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	001	0	1	01	01	H4853_001_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	001	0	1	01	01	H4853_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	001	0	1	01	01	H4853_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				748.03	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	001	0	1	01	01	H4853_001_0	6		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	001	0	1	01	01	H4853_001_0	6		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4853	002	0	1	01	01	H4853_002_0	7		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	002	0	1	01	01	H4853_002_0	7		N	Generic	4	11	1	1	2	1	110		01	110		1	30		90				1	2	30		90				30		31				8.16	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	002	0	1	01	01	H4853_002_0	7		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	30		90				1	2	30		90				30		31				104.60	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	002	0	1	01	01	H4853_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				66.58	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	002	0	1	01	01	H4853_002_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				636.24	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	002	0	1	01	01	H4853_002_0	7		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	002	0	1	01	01	H4853_002_0	7		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4853	014	0	1	01	01	H4853_014_0	7		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	014	0	1	01	01	H4853_014_0	7		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	014	0	1	01	01	H4853_014_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	014	0	1	01	01	H4853_014_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	014	0	1	01	01	H4853_014_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				735.67	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	014	0	1	01	01	H4853_014_0	7		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4853	014	0	1	01	01	H4853_014_0	7		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H4868	002	0	1	01	01	H4868_002_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	002	0	1	01	01	H4868_002_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	002	0	1	01	01	H4868_002_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	002	0	1	01	01	H4868_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.55	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	002	0	1	01	01	H4868_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	004	0	1	01	01	H4868_004_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	004	0	1	01	01	H4868_004_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.1				0.1	0.1	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	004	0	1	01	01	H4868_004_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	004	0	1	01	01	H4868_004_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.03	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	004	0	1	01	01	H4868_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H4868	010	0	1	01	01	H4868_010_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.47	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	010	0	1	01	01	H4868_010_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	014	0	1	01	01	H4868_014_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	014	0	1	01	01	H4868_014_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	014	0	1	01	01	H4868_014_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	014	0	1	01	01	H4868_014_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.45	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	014	0	1	01	01	H4868_014_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	016	0	1	01	01	H4868_016_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	016	0	1	01	01	H4868_016_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	016	0	1	01	01	H4868_016_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	016	0	1	01	01	H4868_016_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.57	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	016	0	1	01	01	H4868_016_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	018	0	1	01	01	H4868_018_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	018	0	1	01	01	H4868_018_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	018	0	1	01	01	H4868_018_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	018	0	1	01	01	H4868_018_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				77.47	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	018	0	1	01	01	H4868_018_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	019	0	1	01	01	H4868_019_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	019	0	1	01	01	H4868_019_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	019	0	1	01	01	H4868_019_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	019	0	1	01	01	H4868_019_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.53	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	019	0	1	01	01	H4868_019_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	020	0	1	01	01	H4868_020_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	020	0	1	01	01	H4868_020_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4868	020	0	1	01	01	H4868_020_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	020	0	1	01	01	H4868_020_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	020	0	1	01	01	H4868_020_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				77.08	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	020	0	1	01	01	H4868_020_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	022	0	1	01	01	H4868_022_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	022	0	1	01	01	H4868_022_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4868	022	0	1	01	01	H4868_022_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	022	0	1	01	01	H4868_022_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	022	0	1	01	01	H4868_022_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.60	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4868	022	0	1	01	01	H4868_022_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.63	50	50	50				38.43	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.63	50	50	50				38.43	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.63	50	50	50				38.43	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.63	50	50	50				38.43	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											36.63	50	50	50				38.43	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											35.42	50	50	50				37.09	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											35.42	50	50	50				37.09	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											35.42	50	50	50				37.09	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											35.42	50	50	50				37.09	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											35.42	50	50	50				37.09	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	1	1	04	01	H4875_018_1	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	0.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	1	1	04	01	H4875_018_1	9		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	0.00																18.00				18.00			0.60	0.43	0.43			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	1	1	04	01	H4875_018_1	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	1	1	04	01	H4875_018_1	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.99	50	50	50				60.28	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	1	1	04	01	H4875_018_1	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	2	1	04	01	H4875_018_2	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	0.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	2	1	04	01	H4875_018_2	9		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	0.00																18.00				18.00			0.60	0.43	0.43			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	2	1	04	01	H4875_018_2	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	2	1	04	01	H4875_018_2	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.99	50	50	50				60.28	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	2	1	04	01	H4875_018_2	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	3	1	04	01	H4875_018_3	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	0.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	3	1	04	01	H4875_018_3	9		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	0.00																18.00				18.00			0.60	0.43	0.43			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	3	1	04	01	H4875_018_3	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	3	1	04	01	H4875_018_3	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.99	50	50	50				60.28	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	3	1	04	01	H4875_018_3	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	4	1	04	01	H4875_018_4	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	0.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	4	1	04	01	H4875_018_4	9		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	0.00																18.00				18.00			0.60	0.43	0.43			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	4	1	04	01	H4875_018_4	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	4	1	04	01	H4875_018_4	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.99	50	50	50				60.28	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	4	1	04	01	H4875_018_4	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	5	1	04	01	H4875_018_5	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	0.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	5	1	04	01	H4875_018_5	9		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	0.00																18.00				18.00			0.60	0.43	0.43			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	5	1	04	01	H4875_018_5	9		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	5	1	04	01	H4875_018_5	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.99	50	50	50				60.28	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	018	5	1	04	01	H4875_018_5	9		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					2.00	4.00	6.00					2.00	4.00	0.00																6.00				6.00			0.20	0.07	0.07			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											41.07	45	45	45				36.38	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	1	1	04	01	H4875_020_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											100.00	33						100.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					2.00	4.00	6.00					2.00	4.00	0.00																6.00				6.00			0.20	0.07	0.07			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											41.07	45	45	45				36.38	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	2	1	04	01	H4875_020_2	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											100.00	33						100.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					2.00	4.00	6.00					2.00	4.00	0.00																6.00				6.00			0.20	0.07	0.07			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											41.07	45	45	45				36.38	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	020	3	1	04	01	H4875_020_3	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											100.00	33						100.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	0.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											60.66	50	50	50				52.30	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	1	1	04	01	H4875_021_1	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	0.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											60.66	50	50	50				52.30	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	021	2	1	04	01	H4875_021_2	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	10		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	10		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	10		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	10		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.84	50	50	50				61.79	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	1	1	04	01	H4875_022_1	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	26						1.00	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	10		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	10		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	10		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	10		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.84	50	50	50				61.79	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	2	1	04	01	H4875_022_2	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	26						1.00	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	10		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	10		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					4.00	8.00	12.00					4.00	8.00	0.00																10.00				10.00			0.33	0.13	0.13			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	10		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	10		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											69.84	50	50	50				61.79	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	022	5	1	04	01	H4875_022_5	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	26						1.00	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	7		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		24.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.52	40		40																								40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	001	0	1	04	01	H4882_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		16.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_0	6		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		28.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.71	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	002	0	1	04	01	H4882_002_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	8		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	8		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	8		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.28	40		40																								40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	003	0	1	04	01	H4882_003_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	4		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	004	0	1	04	01	H4882_004_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				281.34	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	6		Y	Preferred Generic	4	01	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4882	005	0	1	04	01	H4882_005_0	6		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	6		Y	Generic	4	01	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		18.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4882	005	0	1	04	01	H4882_005_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		290.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	005	0	1	04	01	H4882_005_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				275.95	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	006	0	1	04	01	H4882_006_0	6		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		10.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	006	0	1	04	01	H4882_006_0	6		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	006	0	1	04	01	H4882_006_0	6		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	006	0	1	04	01	H4882_006_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.84	40		40																								40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4882	006	0	1	04	01	H4882_006_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4909	014	0	1	04	01	H4909_014_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	015	0	1	04	01	H4909_015_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	015	0	1	04	01	H4909_015_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	016	0	1	04	01	H4909_016_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					0.00	0.00	0.00																9.00				9.00			0.30	0.13	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	016	0	1	04	01	H4909_016_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	018	0	1	04	01	H4909_018_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4909	018	0	1	04	01	H4909_018_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								36.00	72.00	108.00					36.00	72.00	108.00					36.00	108.00	108.00																36.00				36.00			1.20	1.20	1.20			1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	018	0	1	04	01	H4909_018_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4922	011	0	1	01	01	H4922_011_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	7.50																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	7.50																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4922	011	0	1	01	01	H4922_011_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	37.50																					22.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	129.25																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_0	6		N	Non-Preferred Drug	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	275.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4922	011	0	1	01	01	H4922_011_0	6		N	Specialty Tier	4	11	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	26	26	26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4937	001	0	1	04	01	H4937_001_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4937	001	0	1	04	01	H4937_001_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4937	001	0	1	04	01	H4937_001_0	8		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								20.00	40.00	60.00					15.00	30.00	22.50							22.50																20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4937	001	0	1	04	01	H4937_001_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4937	001	0	1	04	01	H4937_001_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	300.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4937	001	0	1	04	01	H4937_001_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											847.59	25						847.59	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4961	001	0	1	04	01	H4961_001_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1069.00	33						1069.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	001	0	1	04	01	H4961_001_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4961	002	0	1	04	01	H4961_002_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	002	0	1	04	01	H4961_002_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	002	0	1	04	01	H4961_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	002	0	1	04	01	H4961_002_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	002	0	1	04	01	H4961_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1062.00	33						1062.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	002	0	1	04	01	H4961_002_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	002	0	1	04	01	H4961_002_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4961	003	0	1	04	01	H4961_003_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1074.00	33						1074.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	003	0	1	04	01	H4961_003_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4961	004	0	1	04	01	H4961_004_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	004	0	1	04	01	H4961_004_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																	12.00			5.00			0.40	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	004	0	1	04	01	H4961_004_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	004	0	1	04	01	H4961_004_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	004	0	1	04	01	H4961_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											1064.00	33						1064.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	004	0	1	04	01	H4961_004_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	004	0	1	04	01	H4961_004_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4961	006	0	1	04	01	H4961_006_0	6		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	6		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																	10.00			3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	6		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											946.00	33						946.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4961	006	0	1	04	01	H4961_006_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								3.00	6.00	0.00					3.00	6.00	0.00					3.00	6.00	0.00																	3.00			3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4982	001	0	1	01	01	H4982_001_0	6		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	001	0	1	01	01	H4982_001_0	6		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	001	0	1	01	01	H4982_001_0	6		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	001	0	1	01	01	H4982_001_0	6		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	001	0	1	01	01	H4982_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	001	0	1	01	01	H4982_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	001	0	1	01	01	H4982_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											669.34	33						522.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	002	0	1	01	01	H4982_002_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	002	0	1	01	01	H4982_002_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	002	0	1	01	01	H4982_002_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	002	0	1	01	01	H4982_002_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	002	0	1	01	01	H4982_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	002	0	1	01	01	H4982_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	002	0	1	01	01	H4982_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											702.17	33						547.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	003	0	1	01	01	H4982_003_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	003	0	1	01	01	H4982_003_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	003	0	1	01	01	H4982_003_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	003	0	1	01	01	H4982_003_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	003	0	1	01	01	H4982_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	003	0	1	01	01	H4982_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	003	0	1	01	01	H4982_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											662.19	33						518.86	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	004	0	1	01	01	H4982_004_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	004	0	1	01	01	H4982_004_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	004	0	1	01	01	H4982_004_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	004	0	1	01	01	H4982_004_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	004	0	1	01	01	H4982_004_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	004	0	1	01	01	H4982_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	004	0	1	01	01	H4982_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											695.04	33						542.80	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	005	0	1	01	01	H4982_005_0	4		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	005	0	1	01	01	H4982_005_0	4		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	005	0	1	01	01	H4982_005_0	4		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	005	0	1	01	01	H4982_005_0	4		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	005	0	1	01	01	H4982_005_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	005	0	1	01	01	H4982_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	005	0	1	01	01	H4982_005_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											660.05	33						515.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	006	0	1	01	01	H4982_006_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	006	0	1	01	01	H4982_006_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	006	0	1	01	01	H4982_006_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	006	0	1	01	01	H4982_006_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	006	0	1	01	01	H4982_006_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	006	0	1	01	01	H4982_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	006	0	1	01	01	H4982_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											666.88	33						520.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	007	0	1	01	01	H4982_007_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	007	0	1	01	01	H4982_007_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	007	0	1	01	01	H4982_007_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	007	0	1	01	01	H4982_007_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	007	0	1	01	01	H4982_007_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	007	0	1	01	01	H4982_007_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	007	0	1	01	01	H4982_007_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											669.63	33						521.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	008	0	1	01	01	H4982_008_0	3		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	008	0	1	01	01	H4982_008_0	3		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	008	0	1	01	01	H4982_008_0	3		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	008	0	1	01	01	H4982_008_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	008	0	1	01	01	H4982_008_0	3		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				485.93	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	009	0	1	01	01	H4982_009_0	3		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	009	0	1	01	01	H4982_009_0	3		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	009	0	1	01	01	H4982_009_0	3		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	009	0	1	01	01	H4982_009_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	009	0	1	01	01	H4982_009_0	3		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				477.36	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	010	0	1	01	01	H4982_010_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	010	0	1	01	01	H4982_010_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	010	0	1	01	01	H4982_010_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	010	0	1	01	01	H4982_010_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	010	0	1	01	01	H4982_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	010	0	1	01	01	H4982_010_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	010	0	1	01	01	H4982_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											629.76	33						489.78	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	011	0	1	01	01	H4982_011_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	011	0	1	01	01	H4982_011_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	011	0	1	01	01	H4982_011_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	011	0	1	01	01	H4982_011_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	011	0	1	01	01	H4982_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	011	0	1	01	01	H4982_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	011	0	1	01	01	H4982_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											689.66	33						537.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	012	0	1	01	01	H4982_012_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	012	0	1	01	01	H4982_012_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	012	0	1	01	01	H4982_012_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H4982	012	0	1	01	01	H4982_012_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H4982	012	0	1	01	01	H4982_012_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	012	0	1	01	01	H4982_012_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	012	0	1	01	01	H4982_012_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											628.13	33						490.08	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	015	0	1	01	01	H4982_015_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	015	0	1	01	01	H4982_015_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	015	0	1	01	01	H4982_015_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											30.39	25	25	25				31.77	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	015	0	1	01	01	H4982_015_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.36	35	35	35				50.37	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H4982	015	0	1	01	01	H4982_015_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											503.28	29						397.95	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5009	002	0	1	04	01	H5009_002_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											795.65	28						795.65	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	008	0	1	04	01	H5009_008_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											795.65	28						795.65	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	009	0	1	04	01	H5009_009_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	009	0	1	04	01	H5009_009_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	009	0	1	04	01	H5009_009_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	009	0	1	04	01	H5009_009_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5009	009	0	1	04	01	H5009_009_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											767.23	27						767.23	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	002	0	1	04	01	H5010_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	004	0	1	04	01	H5010_004_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											937.73	33						937.73	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	007	0	1	04	01	H5010_007_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	007	0	1	04	01	H5010_007_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	007	0	1	04	01	H5010_007_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	007	0	1	04	01	H5010_007_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5010	007	0	1	04	01	H5010_007_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											767.23	27						767.23	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	13		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	13		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		34.00				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	13		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	13		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		250.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	009	0	1	04	01	H5042_009_0	13		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1399.46	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	011	0	1	04	01	H5042_011_0	13		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	011	0	1	04	01	H5042_011_0	13		Y	Generic	4	01	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		28.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	011	0	1	04	01	H5042_011_0	13		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		88.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	011	0	1	04	01	H5042_011_0	13		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	95.00		285.00																									95.00		285.00				95.00		237.50				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5042	011	0	1	04	01	H5042_011_0	13		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				1399.46	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	004	0	1	01	01	H5050_004_0	11		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	11		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	004	0	1	01	01	H5050_004_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	11		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				917.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	11		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	004	0	1	01	01	H5050_004_0	11		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	009	0	1	01	01	H5050_009_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	009	0	1	01	01	H5050_009_0	11		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	11		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	009	0	1	01	01	H5050_009_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	11		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				801.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	11		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	009	0	1	01	01	H5050_009_0	11		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	013	0	1	01	01	H5050_013_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	10		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	013	0	1	01	01	H5050_013_0	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	10		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	013	0	1	01	01	H5050_013_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	10		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				652.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	10		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	013	0	1	01	01	H5050_013_0	10		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	017	0	1	01	01	H5050_017_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	017	0	1	01	01	H5050_017_0	11		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	11		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	017	0	1	01	01	H5050_017_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	11		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				612.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	11		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	017	0	1	01	01	H5050_017_0	11		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_0	11		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	11		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	019	0	1	01	01	H5050_019_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	11		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				948.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	11		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	019	0	1	01	01	H5050_019_0	11		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_021_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_021_0	11		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	11		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	021	0	1	01	01	H5050_021_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	11		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				437.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	11		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	021	0	1	01	01	H5050_021_0	11		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	022	0	1	01	01	H5050_022_0	12		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	022	0	1	01	01	H5050_022_0	12		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	022	0	1	01	01	H5050_022_0	12		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				716.00	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	022	0	1	01	01	H5050_022_0	12		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	023	0	1	01	01	H5050_023_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	11		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	0.00	0.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	023	0	1	01	01	H5050_023_0	11		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	11		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5050	023	0	1	01	01	H5050_023_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	11		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	99.00	198.00	297.00																			99.00	198.00	198.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				504.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	11		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H5050	023	0	1	01	01	H5050_023_0	11		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H5087	001	0	1	01	01	H5087_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.36	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.11	44		44																								44		44				44		44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5087	005	0	1	01	01	H5087_005_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	25.00		75.00																									25.00		75.00				25.00		50.00				25.00				25.00		0.83				0.83	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5087	016	0	1	01	01	H5087_016_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.32	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	024	0	1	01	01	H5087_024_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	024	0	1	01	01	H5087_024_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5087	024	0	1	01	01	H5087_024_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	024	0	1	01	01	H5087_024_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	024	0	1	01	01	H5087_024_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	024	0	1	01	01	H5087_024_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	025	0	1	01	01	H5087_025_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	025	0	1	01	01	H5087_025_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5087	025	0	1	01	01	H5087_025_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	025	0	1	01	01	H5087_025_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	025	0	1	01	01	H5087_025_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	025	0	1	01	01	H5087_025_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	026	0	1	01	01	H5087_026_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	026	0	1	01	01	H5087_026_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5087	026	0	1	01	01	H5087_026_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	026	0	1	01	01	H5087_026_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	25.00		75.00																									25.00		75.00				25.00		50.00				25.00				25.00		0.83				0.83	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	026	0	1	01	01	H5087_026_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	026	0	1	01	01	H5087_026_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								19.00		57.00					11.00		33.00													57.00						27.00				19.00				19.00			0.61	0.35				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					45.00		135.00													141.00						115.00				47.00				47.00			1.52	1.45				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1110.70	33						1110.70	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	1	1	04	01	H5106_029_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1165.28	33						1165.28	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	7		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					5.00		15.00													45.00						12.00				15.00				15.00			0.48	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					47.00		141.00													141.00						120.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				31		90	1	2						90	31		31								100.00		300.00					100.00		300.00													300.00						275.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	029	2	1	04	01	H5106_029_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1165.28	33						1165.28	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	003	0	1	01	01	H5117_003_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5117	003	0	1	01	01	H5117_003_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	30.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5117	003	0	1	01	01	H5117_003_0	3		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5117	004	0	1	01	01	H5117_004_0	2		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	004	0	1	01	01	H5117_004_0	2		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	33.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	004	0	1	01	01	H5117_004_0	2		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	004	0	1	01	01	H5117_004_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				97.00	49	49	49																		49	49	49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	004	0	1	01	01	H5117_004_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	005	0	1	01	01	H5117_005_0	2		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	005	0	1	01	01	H5117_005_0	2		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	005	0	1	01	01	H5117_005_0	2		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	005	0	1	01	01	H5117_005_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5117	005	0	1	01	01	H5117_005_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	001	0	1	01	01	H5126_001_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	001	0	1	01	01	H5126_001_0	6		N	Generic	4	11	3	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	001	0	1	01	01	H5126_001_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	40.00		120.00																			40.00		120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	001	0	1	01	01	H5126_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5126	001	0	1	01	01	H5126_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				853.08	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5140	001	0	1	04	01	H5140_001_0	11		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	001	0	1	04	01	H5140_001_0	11		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	9.00	9.00	9.00																					9.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	001	0	1	04	01	H5140_001_0	11		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	001	0	1	04	01	H5140_001_0	11		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	001	0	1	04	01	H5140_001_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	002	0	1	04	01	H5140_002_0	12		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	002	0	1	04	01	H5140_002_0	12		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	9.00	9.00	9.00																					9.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	002	0	1	04	01	H5140_002_0	12		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	002	0	1	04	01	H5140_002_0	12		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5140	002	0	1	04	01	H5140_002_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					2.00	4.00	0.00							0.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	10		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	10		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2378.34	30	30	30				2378.34	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					2.00	4.00	0.00							0.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	10		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	10		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2248.08	30	30	30				2248.08	30	30	30						30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					2.00	4.00	0.00							0.00																12.00				12.00			0.40	0.07				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	8		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	8		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.05	25	25	25				174.05	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											222.18	25	25	25				222.18	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	8		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2124.94	25	25	25				2124.94	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	10		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	10		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	025	0	1	04	01	H5141_025_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2292.45	33	33	33				2292.45	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	10		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	10		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	026	0	1	04	01	H5141_026_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2231.72	33	33	33				2231.72	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					2.00	4.00	0.00							0.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	032	0	1	04	01	H5141_032_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2284.07	33	33	33				2284.07	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	033	0	1	04	01	H5141_033_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2292.45	33	33	33				2292.45	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	034	0	1	04	01	H5141_034_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2313.20	33	33	33				2313.20	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	035	0	1	04	01	H5141_035_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2248.08	33	33	33				2248.08	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	036	0	1	04	01	H5141_036_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2292.45	33	33	33				2292.45	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	037	0	1	04	01	H5141_037_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2313.20	33	33	33				2313.20	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	038	0	1	04	01	H5141_038_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2292.45	33	33	33				2292.45	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	7		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.05	25	25	25				174.05	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											222.18	25	25	25				222.18	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	039	0	1	04	01	H5141_039_0	7		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2124.94	25	25	25				2124.94	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	9		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	9		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	9		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	040	0	1	04	01	H5141_040_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2292.46	33	33	33				2292.46	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					2.00	4.00	0.00							0.00																12.00				12.00			0.40	0.07				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	7		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.21	25	25	25				10.21	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.12	25	25	25				174.12	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											221.50	25	25	25				221.50	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	042	0	1	04	01	H5141_042_0	7		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2123.38	25	25	25				2123.38	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	10		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	10		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.05	25	25	25				174.05	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	10		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											222.18	25	25	25				222.18	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	045	0	1	04	01	H5141_045_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2124.94	25	25	25				2124.94	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	046	0	1	04	01	H5141_046_0	12		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	046	0	1	04	01	H5141_046_0	12		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	046	0	1	04	01	H5141_046_0	12		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	046	0	1	04	01	H5141_046_0	12		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	046	0	1	04	01	H5141_046_0	12		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2231.72	33	33	33				2231.72	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	047	0	1	04	01	H5141_047_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	047	0	1	04	01	H5141_047_0	10		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	047	0	1	04	01	H5141_047_0	10		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.05	25	25	25				174.05	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	047	0	1	04	01	H5141_047_0	10		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											222.18	25	25	25				222.18	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	047	0	1	04	01	H5141_047_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2124.94	25	25	25				2124.94	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	048	0	1	04	01	H5141_048_0	12		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	048	0	1	04	01	H5141_048_0	12		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	048	0	1	04	01	H5141_048_0	12		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	048	0	1	04	01	H5141_048_0	12		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	048	0	1	04	01	H5141_048_0	12		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2231.72	33	33	33				2231.72	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	049	0	1	04	01	H5141_049_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	049	0	1	04	01	H5141_049_0	10		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	049	0	1	04	01	H5141_049_0	10		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.05	25	25	25				174.05	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	049	0	1	04	01	H5141_049_0	10		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											222.18	25	25	25				222.18	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	049	0	1	04	01	H5141_049_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2124.94	25	25	25				2124.94	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	13		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	13		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	13		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	13		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	050	0	1	04	01	H5141_050_0	13		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2231.72	33	33	33				2231.72	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	051	0	1	04	01	H5141_051_0	11		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					0.00	0.00	0.00							0.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	051	0	1	04	01	H5141_051_0	11		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.20	25	25	25				10.20	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	051	0	1	04	01	H5141_051_0	11		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.05	25	25	25				174.05	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	051	0	1	04	01	H5141_051_0	11		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											222.18	25	25	25				222.18	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	051	0	1	04	01	H5141_051_0	11		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2124.94	25	25	25				2124.94	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5172	002	0	1	48	05	H5172_002_0	10			Generic Drugs	4	01			1	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	10			Brand Drugs	4	10			2	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	10			Non-Medicare Rx Drugs	4	01			3	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	10			Non-Medicare OTC Drugs	4	01			4	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5190	001	0	1	01	01	H5190_001_0	2		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	2		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	2		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.00	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	2		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	2		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	2		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				87.00	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	2		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	2		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	2		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				98.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	2		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	2		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	2		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				92.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	005	0	1	01	01	H5190_005_0	3		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	1.00	2.00	3.00																			1.00	2.00	3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	005	0	1	01	01	H5190_005_0	3		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	005	0	1	01	01	H5190_005_0	3		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	005	0	1	01	01	H5190_005_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	49	49	49																		49	49	49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	005	0	1	01	01	H5190_005_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	006	0	1	01	01	H5190_006_0	3		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	1.00	2.00	3.00																			1.00	2.00	3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	006	0	1	01	01	H5190_006_0	3		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	006	0	1	01	01	H5190_006_0	3		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	006	0	1	01	01	H5190_006_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	49	49	49																		49	49	49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5190	006	0	1	01	01	H5190_006_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_007_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_007_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5199	007	0	1	04	01	H5199_007_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_007_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_007_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	007	0	1	04	01	H5199_007_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5199	008	0	1	04	01	H5199_008_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	008	0	1	04	01	H5199_008_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5199	010	0	1	04	01	H5199_010_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	010	0	1	04	01	H5199_010_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5199	012	0	1	04	01	H5199_012_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	012	0	1	04	01	H5199_012_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	013	0	1	04	01	H5199_013_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	013	0	1	04	01	H5199_013_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5199	013	0	1	04	01	H5199_013_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	013	0	1	04	01	H5199_013_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	013	0	1	04	01	H5199_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	013	0	1	04	01	H5199_013_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	014	0	1	04	01	H5199_014_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	014	0	1	04	01	H5199_014_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5199	014	0	1	04	01	H5199_014_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	014	0	1	04	01	H5199_014_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	014	0	1	04	01	H5199_014_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	014	0	1	04	01	H5199_014_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	015	0	1	04	01	H5199_015_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	015	0	1	04	01	H5199_015_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5199	015	0	1	04	01	H5199_015_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	015	0	1	04	01	H5199_015_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	015	0	1	04	01	H5199_015_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5199	015	0	1	04	01	H5199_015_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5211	002	0	1	02	01	H5211_002_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.12			0.12			0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	8		Y	Generic	4	11	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.38			0.38			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1882.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	8		Y	Vaccines	4	11	1	2	6	1	010		01			1	31														31		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.29			0.29			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				2716.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	7		Y	Vaccines	4	11	1	2	6	1	010		01			1	31														31		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				2069.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	7		Y	Vaccines	4	11	1	2	6	1	010		01			1	31														31		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.26			0.26			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1882.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	7		Y	Vaccines	4	11	1	2	6	1	010		01			1	31														31		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.19			0.19			0.17	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				2028.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	7		Y	Vaccines	4	11	1	2	6	1	010		01			1	31														31		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.19			0.19			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1842.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	012	0	1	02	01	H5211_012_0	7		Y	Vaccines	4	11	1	2	6	1	010		01			1	31														31		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.12			0.12			0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	7		Y	Generic	4	11	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.38			0.38			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		34				1882.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	013	0	1	02	01	H5211_013_0	7		Y	Vaccines	4	11	1	2	6	1	010		01			1	31														31		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5215	002	0	1	04	01	H5215_002_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		0.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																90.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		0.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																90.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7		N	Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		15.00					4.00		10.00					4.00		0.00																4.00				4.00			0.20	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7		N	Generic	3	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7		N	Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7		N	Non-Preferred Brand	3	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																90.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	7		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		0.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																90.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		0.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																90.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		0.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																90.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	8		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		0.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	8		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	8		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																90.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	011	0	1	04	01	H5215_011_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	017	0	1	04	01	H5216_017_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	018	0	1	04	01	H5216_018_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	018	0	1	04	01	H5216_018_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	018	0	1	04	01	H5216_018_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	018	0	1	04	01	H5216_018_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	018	0	1	04	01	H5216_018_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	019	0	1	04	01	H5216_019_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	021	0	1	04	01	H5216_021_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	022	0	1	04	01	H5216_022_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	023	0	1	04	01	H5216_023_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	024	0	1	04	01	H5216_024_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	027	0	1	04	01	H5216_027_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	028	0	1	04	01	H5216_028_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	028	0	1	04	01	H5216_028_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	028	0	1	04	01	H5216_028_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	028	0	1	04	01	H5216_028_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	028	0	1	04	01	H5216_028_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	029	0	1	04	01	H5216_029_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	032	0	1	04	01	H5216_032_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	1	1	04	01	H5216_033_1	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	1	1	04	01	H5216_033_1	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	1	1	04	01	H5216_033_1	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	1	1	04	01	H5216_033_1	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	1	1	04	01	H5216_033_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	033	2	1	04	01	H5216_033_2	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	034	0	1	04	01	H5216_034_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					7.00		21.00											20.00		60.00				7.00		0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	036	0	1	04	01	H5216_036_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	037	0	1	04	01	H5216_037_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	039	0	1	04	01	H5216_039_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	042	0	1	04	01	H5216_042_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	1	1	04	01	H5216_043_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	043	2	1	04	01	H5216_043_2	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	044	0	1	04	01	H5216_044_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	047	0	1	04	01	H5216_047_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								18.00		54.00					16.00		48.00											18.00		54.00				16.00		0.00				18.00				18.00			0.60	0.53		0.60	0.53	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	048	0	1	04	01	H5216_048_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	050	0	1	04	01	H5216_050_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	051	0	1	04	01	H5216_051_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	1	1	04	01	H5216_052_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	052	2	1	04	01	H5216_052_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	053	0	1	04	01	H5216_053_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	054	0	1	04	01	H5216_054_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	055	0	1	04	01	H5216_055_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	057	0	1	04	01	H5216_057_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	058	0	1	04	01	H5216_058_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	061	0	1	04	01	H5216_061_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	062	0	1	04	01	H5216_062_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	063	0	1	04	01	H5216_063_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	064	0	1	04	01	H5216_064_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	065	0	1	04	01	H5216_065_0	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	065	0	1	04	01	H5216_065_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	065	0	1	04	01	H5216_065_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	065	0	1	04	01	H5216_065_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	065	0	1	04	01	H5216_065_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	068	0	1	04	01	H5216_068_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	070	0	1	04	01	H5216_070_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	071	0	1	04	01	H5216_071_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	072	0	1	04	01	H5216_072_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	073	0	1	04	01	H5216_073_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	074	0	1	04	01	H5216_074_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	075	0	1	04	01	H5216_075_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	1	1	04	01	H5216_078_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	078	2	1	04	01	H5216_078_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	1	1	04	01	H5216_080_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	2	1	04	01	H5216_080_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	080	3	1	04	01	H5216_080_3	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	2		N	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	081	0	1	04	01	H5216_081_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	083	0	1	04	01	H5216_083_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	088	0	1	04	01	H5216_088_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	089	0	1	04	01	H5216_089_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				85.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	092	0	1	04	01	H5216_092_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	093	0	1	04	01	H5216_093_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	096	0	1	04	01	H5216_096_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	097	0	1	04	01	H5216_097_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	098	0	1	04	01	H5216_098_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	099	0	1	04	01	H5216_099_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	100	0	1	04	01	H5216_100_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	103	0	1	04	01	H5216_103_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	106	0	1	04	01	H5216_106_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	107	0	1	04	01	H5216_107_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	109	0	1	04	01	H5216_109_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	111	0	1	04	01	H5216_111_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	112	0	1	04	01	H5216_112_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	114	0	1	04	01	H5216_114_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	115	0	1	04	01	H5216_115_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	117	0	1	04	01	H5216_117_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	120	0	1	04	01	H5216_120_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	124	0	1	04	01	H5216_124_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	125	0	1	04	01	H5216_125_0	4		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.17	0.07		0.17	0.07	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	125	0	1	04	01	H5216_125_0	4		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	125	0	1	04	01	H5216_125_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	125	0	1	04	01	H5216_125_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	125	0	1	04	01	H5216_125_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	131	0	1	04	01	H5216_131_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	132	0	1	04	01	H5216_132_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	133	0	1	04	01	H5216_133_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	136	0	1	04	01	H5216_136_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	137	0	1	04	01	H5216_137_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	138	0	1	04	01	H5216_138_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	139	0	1	04	01	H5216_139_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	139	0	1	04	01	H5216_139_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	139	0	1	04	01	H5216_139_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	139	0	1	04	01	H5216_139_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	139	0	1	04	01	H5216_139_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	141	0	1	04	01	H5216_141_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	1	1	04	01	H5216_142_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	142	2	1	04	01	H5216_142_2	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	143	0	1	04	01	H5216_143_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	144	0	1	04	01	H5216_144_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	149	0	1	04	01	H5216_149_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	154	0	1	04	01	H5216_154_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	4		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	4		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	158	0	1	04	01	H5216_158_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	160	0	1	04	01	H5216_160_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	161	0	1	04	01	H5216_161_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	163	0	1	04	01	H5216_163_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_0	5		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_0	5		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_0	5		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_0	5		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	164	0	1	04	01	H5216_164_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	165	0	1	04	01	H5216_165_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	166	0	1	04	01	H5216_166_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	167	0	1	04	01	H5216_167_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				70.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	168	0	1	04	01	H5216_168_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	169	0	1	04	01	H5216_169_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	170	0	1	04	01	H5216_170_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	171	0	1	04	01	H5216_171_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	172	0	1	04	01	H5216_172_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	173	0	1	04	01	H5216_173_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	175	0	1	04	01	H5216_175_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					12.00		36.00											18.00		54.00				12.00		0.00				18.00				18.00			0.60	0.40		0.60	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	176	0	1	04	01	H5216_176_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	177	0	1	04	01	H5216_177_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	179	0	1	04	01	H5216_179_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	180	0	1	04	01	H5216_180_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	181	0	1	04	01	H5216_181_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	182	0	1	04	01	H5216_182_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	185	0	1	04	01	H5216_185_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	186	0	1	04	01	H5216_186_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	188	0	1	04	01	H5216_188_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	189	0	1	04	01	H5216_189_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	192	0	1	04	01	H5216_192_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	193	0	1	04	01	H5216_193_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	194	0	1	04	01	H5216_194_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	195	0	1	04	01	H5216_195_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	1	1	04	01	H5216_196_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	196	2	1	04	01	H5216_196_2	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	197	0	1	04	01	H5216_197_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	198	0	1	04	01	H5216_198_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	199	0	1	04	01	H5216_199_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	6		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	6		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	202	0	1	04	01	H5216_202_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	1	1	04	01	H5216_203_1	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	203	2	1	04	01	H5216_203_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	205	0	1	04	01	H5216_205_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	205	0	1	04	01	H5216_205_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	205	0	1	04	01	H5216_205_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	205	0	1	04	01	H5216_205_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	205	0	1	04	01	H5216_205_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	206	0	1	04	01	H5216_206_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	206	0	1	04	01	H5216_206_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	206	0	1	04	01	H5216_206_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	206	0	1	04	01	H5216_206_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	206	0	1	04	01	H5216_206_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	207	0	1	04	01	H5216_207_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	207	0	1	04	01	H5216_207_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	207	0	1	04	01	H5216_207_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	207	0	1	04	01	H5216_207_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	207	0	1	04	01	H5216_207_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	209	0	1	04	01	H5216_209_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	209	0	1	04	01	H5216_209_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	209	0	1	04	01	H5216_209_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	209	0	1	04	01	H5216_209_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	209	0	1	04	01	H5216_209_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	210	0	1	04	01	H5216_210_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	210	0	1	04	01	H5216_210_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	210	0	1	04	01	H5216_210_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	210	0	1	04	01	H5216_210_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	210	0	1	04	01	H5216_210_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	211	0	1	04	01	H5216_211_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	212	0	1	04	01	H5216_212_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	1	1	04	01	H5216_214_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	2	1	04	01	H5216_214_2	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	214	3	1	04	01	H5216_214_3	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	215	0	1	04	01	H5216_215_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	219	0	1	04	01	H5216_219_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	219	0	1	04	01	H5216_219_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	219	0	1	04	01	H5216_219_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	219	0	1	04	01	H5216_219_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	219	0	1	04	01	H5216_219_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	220	0	1	04	01	H5216_220_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	220	0	1	04	01	H5216_220_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	220	0	1	04	01	H5216_220_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	220	0	1	04	01	H5216_220_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	220	0	1	04	01	H5216_220_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	222	0	1	04	01	H5216_222_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	222	0	1	04	01	H5216_222_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	222	0	1	04	01	H5216_222_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	222	0	1	04	01	H5216_222_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	222	0	1	04	01	H5216_222_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	223	0	1	04	01	H5216_223_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	224	0	1	04	01	H5216_224_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	226	0	1	04	01	H5216_226_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	227	0	1	04	01	H5216_227_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.17	0.07		0.17	0.07	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	227	0	1	04	01	H5216_227_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	227	0	1	04	01	H5216_227_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	227	0	1	04	01	H5216_227_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	227	0	1	04	01	H5216_227_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	228	0	1	04	01	H5216_228_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	228	0	1	04	01	H5216_228_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	228	0	1	04	01	H5216_228_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	228	0	1	04	01	H5216_228_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	228	0	1	04	01	H5216_228_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	229	0	1	04	01	H5216_229_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	230	0	1	04	01	H5216_230_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	230	0	1	04	01	H5216_230_0	2		N	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	230	0	1	04	01	H5216_230_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	230	0	1	04	01	H5216_230_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	230	0	1	04	01	H5216_230_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	6		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	6		N	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	231	0	1	04	01	H5216_231_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	1	1	04	01	H5216_232_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	232	2	1	04	01	H5216_232_2	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	1	1	04	01	H5216_233_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	233	2	1	04	01	H5216_233_2	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	1	1	04	01	H5216_237_1	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	1	1	04	01	H5216_237_1	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	1	1	04	01	H5216_237_1	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	1	1	04	01	H5216_237_1	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	1	1	04	01	H5216_237_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	2	1	04	01	H5216_237_2	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	2	1	04	01	H5216_237_2	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	2	1	04	01	H5216_237_2	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	2	1	04	01	H5216_237_2	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	237	2	1	04	01	H5216_237_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	1	1	04	01	H5216_238_1	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	1	1	04	01	H5216_238_1	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	1	1	04	01	H5216_238_1	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	1	1	04	01	H5216_238_1	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	1	1	04	01	H5216_238_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	2	1	04	01	H5216_238_2	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	2	1	04	01	H5216_238_2	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	2	1	04	01	H5216_238_2	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	2	1	04	01	H5216_238_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	238	2	1	04	01	H5216_238_2	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	239	0	1	04	01	H5216_239_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	240	0	1	04	01	H5216_240_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	241	0	1	04	01	H5216_241_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	241	0	1	04	01	H5216_241_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	241	0	1	04	01	H5216_241_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	241	0	1	04	01	H5216_241_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	241	0	1	04	01	H5216_241_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	242	0	1	04	01	H5216_242_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	243	0	1	04	01	H5216_243_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	244	0	1	04	01	H5216_244_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	245	0	1	04	01	H5216_245_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	245	0	1	04	01	H5216_245_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	245	0	1	04	01	H5216_245_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	245	0	1	04	01	H5216_245_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	245	0	1	04	01	H5216_245_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	246	0	1	04	01	H5216_246_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	247	0	1	04	01	H5216_247_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	1	1	04	01	H5216_248_1	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	248	2	1	04	01	H5216_248_2	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	249	0	1	04	01	H5216_249_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	250	0	1	04	01	H5216_250_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	251	0	1	04	01	H5216_251_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	252	0	1	04	01	H5216_252_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	253	0	1	04	01	H5216_253_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	254	0	1	04	01	H5216_254_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	255	0	1	04	01	H5216_255_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	5		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5232	001	0	1	04	01	H5232_001_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5232	001	0	1	04	01	H5232_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				913.81	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	004	0	1	02	01	H5253_004_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	02	01	H5253_004_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				248.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	011	0	1	02	01	H5253_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	02	01	H5253_011_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				273.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	030	0	1	02	01	H5253_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	02	01	H5253_030_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				302.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	033	0	1	02	01	H5253_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	02	01	H5253_033_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				372.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	034	0	1	02	01	H5253_034_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	02	01	H5253_034_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				162.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	035	0	1	02	01	H5253_035_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				358.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	036	0	1	01	01	H5253_036_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				212.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	037	0	1	02	01	H5253_037_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	02	01	H5253_037_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				310.00	32																										32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	038	0	1	02	01	H5253_038_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	02	01	H5253_038_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				341.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	039	0	1	02	01	H5253_039_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	02	01	H5253_039_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				428.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	043	0	1	02	01	H5253_043_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				251.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	047	0	1	01	01	H5253_047_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	01	01	H5253_047_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				353.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	048	0	1	01	01	H5253_048_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	01	01	H5253_048_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				423.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	049	0	1	01	01	H5253_049_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				347.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	050	0	1	01	01	H5253_050_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	050	0	1	01	01	H5253_050_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				389.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	051	0	1	01	01	H5253_051_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	051	0	1	01	01	H5253_051_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				383.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	052	0	1	01	01	H5253_052_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				250.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	061	0	1	02	01	H5253_061_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				242.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	062	0	1	01	01	H5253_062_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				259.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	064	0	1	02	01	H5253_064_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				332.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	067	0	1	01	01	H5253_067_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	067	0	1	01	01	H5253_067_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				344.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	072	0	1	02	01	H5253_072_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	02	01	H5253_072_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				144.00	26																										26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	073	0	1	02	01	H5253_073_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	02	01	H5253_073_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				313.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	079	0	1	02	01	H5253_079_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	02	01	H5253_079_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				366.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	080	0	1	02	01	H5253_080_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	02	01	H5253_080_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				267.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	081	0	1	01	01	H5253_081_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				415.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	082	0	1	01	01	H5253_082_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				492.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	083	0	1	01	01	H5253_083_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				358.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	084	0	1	01	01	H5253_084_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				354.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	087	0	1	02	01	H5253_087_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	02	01	H5253_087_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				381.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	088	0	1	02	01	H5253_088_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	02	01	H5253_088_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				374.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	089	0	1	02	01	H5253_089_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	02	01	H5253_089_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				253.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	091	0	1	01	01	H5253_091_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	091	0	1	01	01	H5253_091_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	091	0	1	01	01	H5253_091_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	091	0	1	01	01	H5253_091_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	091	0	1	01	01	H5253_091_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	091	0	1	01	01	H5253_091_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				233.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	01	01	H5253_097_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	01	01	H5253_097_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	01	01	H5253_097_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	097	0	1	01	01	H5253_097_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	01	01	H5253_097_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	097	0	1	01	01	H5253_097_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				207.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	099	0	1	01	01	H5253_099_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	099	0	1	01	01	H5253_099_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				218.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	100	0	1	01	01	H5253_100_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	100	0	1	01	01	H5253_100_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	100	0	1	01	01	H5253_100_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				318.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	102	0	1	02	01	H5253_102_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	102	0	1	02	01	H5253_102_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				389.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	103	0	1	02	01	H5253_103_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	103	0	1	02	01	H5253_103_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				295.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	104	0	1	02	01	H5253_104_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	104	0	1	02	01	H5253_104_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				240.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	105	0	1	02	01	H5253_105_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	105	0	1	02	01	H5253_105_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											278.00	25						348.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	107	1	1	02	01	H5253_107_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	1	1	02	01	H5253_107_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				367.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	107	2	1	02	01	H5253_107_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	107	2	1	02	01	H5253_107_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				367.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	108	1	1	02	01	H5253_108_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	1	1	02	01	H5253_108_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				363.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	108	2	1	02	01	H5253_108_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	2	1	02	01	H5253_108_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				363.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	108	3	1	02	01	H5253_108_3	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	108	3	1	02	01	H5253_108_3	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				363.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	01	01	H5253_109_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	01	01	H5253_109_1	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	109	1	1	01	01	H5253_109_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	01	01	H5253_109_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	109	1	1	01	01	H5253_109_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	01	01	H5253_109_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	1	1	01	01	H5253_109_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				250.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5253	109	2	1	01	01	H5253_109_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5253	109	2	1	01	01	H5253_109_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	109	2	1	01	01	H5253_109_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				250.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	110	0	1	02	01	H5253_110_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	110	0	1	02	01	H5253_110_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											254.00	25						261.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	13.00		26.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	13.00		26.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	111	1	1	02	01	H5253_111_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	1	1	02	01	H5253_111_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				336.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	13.00		26.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	13.00		26.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	111	2	1	02	01	H5253_111_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	111	2	1	02	01	H5253_111_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				336.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	112	1	1	02	01	H5253_112_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	1	1	02	01	H5253_112_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				470.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5253	112	2	1	02	01	H5253_112_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	112	2	1	02	01	H5253_112_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				470.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				89.18	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				94.74	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	7		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	7		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				92.14	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				91.69	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	8.00	16.00	24.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				99.27	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	5		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	8.00	16.00	24.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				87.52	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	018	0	1	01	01	H5262_018_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	018	0	1	01	01	H5262_018_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	018	0	1	01	01	H5262_018_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	018	0	1	01	01	H5262_018_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				92.71	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	018	0	1	01	01	H5262_018_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	019	0	1	01	01	H5262_019_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	019	0	1	01	01	H5262_019_0	5		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	019	0	1	01	01	H5262_019_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	019	0	1	01	01	H5262_019_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				94.82	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	019	0	1	01	01	H5262_019_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	021	0	1	01	01	H5262_021_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	021	0	1	01	01	H5262_021_0	5		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	021	0	1	01	01	H5262_021_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	021	0	1	01	01	H5262_021_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				94.76	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	021	0	1	01	01	H5262_021_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	023	0	1	01	01	H5262_023_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	023	0	1	01	01	H5262_023_0	5		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	023	0	1	01	01	H5262_023_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	023	0	1	01	01	H5262_023_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				94.75	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	023	0	1	01	01	H5262_023_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	024	0	1	01	01	H5262_024_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	024	0	1	01	01	H5262_024_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	8.00	16.00	24.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	024	0	1	01	01	H5262_024_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	024	0	1	01	01	H5262_024_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				80.80	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	024	0	1	01	01	H5262_024_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	026	0	1	01	01	H5262_026_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	026	0	1	01	01	H5262_026_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	026	0	1	01	01	H5262_026_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	026	0	1	01	01	H5262_026_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				83.55	30	30	30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	026	0	1	01	01	H5262_026_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5273	001	0	1	01	01	H5273_001_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	001	0	1	01	01	H5273_001_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				0.00			0.50	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	001	0	1	01	01	H5273_001_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	001	0	1	01	01	H5273_001_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	001	0	1	01	01	H5273_001_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	001	0	1	01	01	H5273_001_0	8		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	002	0	1	01	01	H5273_002_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	002	0	1	01	01	H5273_002_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				0.00			0.50	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	002	0	1	01	01	H5273_002_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	002	0	1	01	01	H5273_002_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	002	0	1	01	01	H5273_002_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	002	0	1	01	01	H5273_002_0	8		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	003	0	1	01	01	H5273_003_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				0.00			0.33	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	003	0	1	01	01	H5273_003_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				0.00			0.50	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	003	0	1	01	01	H5273_003_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	003	0	1	01	01	H5273_003_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	003	0	1	01	01	H5273_003_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5273	003	0	1	01	01	H5273_003_0	8		N	Vaccines	4	11	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5280	001	0	1	48	05	H5280_001_0	6			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	6			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5280	001	0	1	48	05	H5280_001_0	6			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5294	010	0	1	01	01	H5294_010_0	4		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	010	0	1	01	01	H5294_010_0	4		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	010	0	1	01	01	H5294_010_0	4		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	010	0	1	01	01	H5294_010_0	4		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				98.68	49	49	49																		49	49	49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	010	0	1	01	01	H5294_010_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	011	0	1	01	01	H5294_011_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	36.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	011	0	1	01	01	H5294_011_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	36.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	012	0	1	01	01	H5294_012_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	013	0	1	01	01	H5294_013_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	013	0	1	01	01	H5294_013_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	013	0	1	01	01	H5294_013_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	013	0	1	01	01	H5294_013_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				84.10	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	013	0	1	01	01	H5294_013_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	015	0	1	01	01	H5294_015_0	3		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	1.00	2.00	3.00																			1.00	2.00	3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	015	0	1	01	01	H5294_015_0	3		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	015	0	1	01	01	H5294_015_0	3		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	015	0	1	01	01	H5294_015_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				96.78	49	49	49																		49	49	49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	015	0	1	01	01	H5294_015_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	016	0	1	01	01	H5294_016_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	016	0	1	01	01	H5294_016_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	016	0	1	01	01	H5294_016_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	016	0	1	01	01	H5294_016_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				84.10	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	016	0	1	01	01	H5294_016_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5294	017	0	1	01	01	H5294_017_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	9.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	36.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	017	0	1	01	01	H5294_017_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					14.00	28.00	42.00					14.00	28.00	42.00																19.00				19.00			0.63	0.47	0.47			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5294	018	0	1	01	01	H5294_018_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								8.00	8.00	8.00					0.00	0.00	0.00					0.00	0.00	0.00																	8.00			0.00			0.27	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											929.00	33						929.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	001	0	1	01	01	H5296_001_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5296	002	0	1	01	01	H5296_002_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	002	0	1	01	01	H5296_002_0	3		N	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								20.00	40.00	60.00					14.00	28.00	42.00					14.00	28.00	42.00																	20.00			14.00			0.67	0.47	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	002	0	1	01	01	H5296_002_0	3		N	Preferred Brand	4	11	1	1	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											81.00	25	25	25				72.00	23	23	23				23	23	23																25		23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	002	0	1	01	01	H5296_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											77.00	25	25	25				65.00	23	23	23				23	23	23																25		23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	002	0	1	01	01	H5296_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											627.00	25						627.00	25						25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	002	0	1	01	01	H5296_002_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								8.00	8.00	8.00					0.00	0.00	0.00					0.00	0.00	0.00																	8.00			0.00			0.27	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											929.00	33						929.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5296	003	0	1	02	01	H5296_003_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5302	011	0	1	01	01	H5302_011_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	011	0	1	01	01	H5302_011_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5302	011	0	1	01	01	H5302_011_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	011	0	1	01	01	H5302_011_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5302	011	0	1	01	01	H5302_011_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	011	0	1	01	01	H5302_011_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	011	0	1	01	01	H5302_011_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											761.85	28						581.56	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	012	0	1	01	01	H5302_012_0	7		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	012	0	1	01	01	H5302_012_0	7		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	012	0	1	01	01	H5302_012_0	7		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											28.70	25	25	25				29.26	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	012	0	1	01	01	H5302_012_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.33	35	35	35				49.54	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	012	0	1	01	01	H5302_012_0	7		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											490.78	29						387.31	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	013	0	1	01	01	H5302_013_0	7		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	013	0	1	01	01	H5302_013_0	7		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	013	0	1	01	01	H5302_013_0	7		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	013	0	1	01	01	H5302_013_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	013	0	1	01	01	H5302_013_0	7		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				483.95	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	014	0	1	01	01	H5302_014_0	7		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	014	0	1	01	01	H5302_014_0	7		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	014	0	1	01	01	H5302_014_0	7		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	014	0	1	01	01	H5302_014_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5302	014	0	1	01	01	H5302_014_0	7		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				482.44	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	001	0	1	01	01	H5325_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	001	0	1	01	01	H5325_001_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	001	0	1	01	01	H5325_001_0	5		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.88	25	25	25				30.65	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	001	0	1	01	01	H5325_001_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.84	35	35	35				50.28	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	001	0	1	01	01	H5325_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											501.15	29						394.64	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	002	0	1	01	01	H5325_002_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	002	0	1	01	01	H5325_002_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	002	0	1	01	01	H5325_002_0	3		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.07	25	25	25				29.79	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	002	0	1	01	01	H5325_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.67	35	35	35				49.41	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	002	0	1	01	01	H5325_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											499.81	29						390.30	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	003	0	1	01	01	H5325_003_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	003	0	1	01	01	H5325_003_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	003	0	1	01	01	H5325_003_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.88	25	25	25				30.65	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	003	0	1	01	01	H5325_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.84	35	35	35				50.28	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	003	0	1	01	01	H5325_003_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											501.15	29						394.64	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	004	0	1	01	01	H5325_004_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	004	0	1	01	01	H5325_004_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	004	0	1	01	01	H5325_004_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.88	25	25	25				30.65	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	004	0	1	01	01	H5325_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.84	35	35	35				50.28	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	004	0	1	01	01	H5325_004_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											501.15	29						394.64	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	005	0	1	01	01	H5325_005_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	005	0	1	01	01	H5325_005_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	005	0	1	01	01	H5325_005_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											29.88	25	25	25				30.65	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	005	0	1	01	01	H5325_005_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.84	35	35	35				50.28	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	005	0	1	01	01	H5325_005_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											501.15	29						394.64	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	006	0	1	01	01	H5325_006_0	3		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	006	0	1	01	01	H5325_006_0	3		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	006	0	1	01	01	H5325_006_0	3		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	006	0	1	01	01	H5325_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5325	006	0	1	01	01	H5325_006_0	3		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				460.45	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5337	001	0	1	01	01	H5337_001_0	5		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5337	001	0	1	01	01	H5337_001_0	5		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5337	001	0	1	01	01	H5337_001_0	5		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5337	001	0	1	01	01	H5337_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5337	001	0	1	01	01	H5337_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				509.76	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5355	001	0	1	48	05	H5355_001_0	2			Generic Drugs	4	01			1	1	110		01	110		1	31		90				2	2	31		90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5355	001	0	1	48	05	H5355_001_0	2			Brand Drugs	4	10			2	1	110		01	110		1	31		90				2	2	31		90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5355	001	0	1	48	05	H5355_001_0	2			Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	110		1	31		90				1	2	31		90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5373	001	0	1	01	01	H5373_001_0	4		Y	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	4		Y	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5373	001	0	1	01	01	H5373_001_0	4		Y	Generic	4	11	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.5			1.5			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5373	001	0	1	01	01	H5373_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				919.13	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5377	001	0	1	01	01	H5377_001_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5386	003	0	1	01	01	H5386_003_0	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		34	2.00	4.00	6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	4		Y	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		34	8.00	16.00	24.00																					0.00																8.00				8.00		0.27						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		34	40.00	80.00	120.00																					80.00																40.00				40.00		1.33						1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		34	95.00	190.00	285.00																					190.00																95.00				95.00		3.17						2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				923.78	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	003	0	1	01	01	H5386_003_0	4		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		34	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	5		Y	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		34	2.00	4.00	6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	5		Y	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		34	8.00	16.00	24.00																					0.00																8.00				8.00		0.27						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		34	40.00	80.00	120.00																					80.00																40.00				40.00		1.33						1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		34	95.00	190.00	285.00																					190.00																95.00				95.00		3.17						2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34				1077.47	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5386	004	0	1	01	01	H5386_004_0	5		Y	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		34	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	001	0	1	01	01	H5398_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5398	002	0	1	01	01	H5398_002_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5410	001	0	1	01	01	H5410_001_0	8		N	Generic	4	11	3	2	1	1		111	01			1				30	60	90	2	2							30		31								5.00	10.00	15.00					0.00	0.00	0.00																							5.00				5.00			0.17	0.00				0.16	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	8		N	Generic	4	11	3	2	1	3		111	01			1				30	60	90	2	2							30		31								5.00	10.00	15.00					0.00	0.00	0.00																							5.00				5.00			0.17	0.00				0.16	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5410	001	0	1	01	01	H5410_001_0	8		N	Preferred Brand	4	10	1	2	2	1		111	01			1				30	60	90	2	2							30		31								20.00	40.00	60.00					0.00	0.00	0.00																							20.00				20.00			0.67	0.00				0.65	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	8		N	Non-Preferred Drug	4	11	1	2	3	1		111	01			1				30	60	90	2	2							30		31								50.00	100.00	150.00					40.00	80.00	105.00																							50.00				50.00			1.67	1.33				1.61	Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	8		N	Specialty Tier	4	11	1	1	4	1		010	01			1				30											30		31											1022.80	33						641.02	33																							33			33								Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	24.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	01	01	H5410_018_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											955.30	33						849.42	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	024	0	1	01	01	H5410_024_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											775.13	33						615.31	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	025	0	1	01	01	H5410_025_0	7		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					1.00	2.00	2.00											17.00	34.00	51.00				0.00	0.00	0.00				17.00				17.00			0.57	0.03		0.57	0.00	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	025	0	1	01	01	H5410_025_0	7		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	025	0	1	01	01	H5410_025_0	7		N	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											33.16	17	17	17				30.05	17	17	17										17	17	17				17	17	17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	025	0	1	01	01	H5410_025_0	7		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											95.81	44	44	44				81.99	44	44	44										44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	025	0	1	01	01	H5410_025_0	7		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											375.57	25						308.71	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	026	0	1	01	01	H5410_026_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.92	33						688.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	027	0	1	01	01	H5410_027_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	027	0	1	01	01	H5410_027_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	027	0	1	01	01	H5410_027_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	027	0	1	01	01	H5410_027_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	027	0	1	01	01	H5410_027_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.92	33						688.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	028	0	1	01	01	H5410_028_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.92	33						688.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	029	0	1	01	01	H5410_029_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	029	0	1	01	01	H5410_029_0	7		N	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5410	029	0	1	01	01	H5410_029_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	029	0	1	01	01	H5410_029_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	029	0	1	01	01	H5410_029_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	029	0	1	01	01	H5410_029_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.92	33						688.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	7		N	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5410	030	0	1	01	01	H5410_030_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	030	0	1	01	01	H5410_030_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.92	33						688.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	031	0	1	01	01	H5410_031_0	7		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					2.00	4.00	4.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.07		0.60	0.00	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	031	0	1	01	01	H5410_031_0	7		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	031	0	1	01	01	H5410_031_0	7		N	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.70	19	19	19				37.36	18	18	18										19	19	19				18	18	18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	031	0	1	01	01	H5410_031_0	7		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.53	39	39	39				87.04	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	031	0	1	01	01	H5410_031_0	7		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											427.79	25						371.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	032	0	1	01	01	H5410_032_0	7		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					2.00	4.00	4.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.07		0.60	0.00	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	032	0	1	01	01	H5410_032_0	7		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	032	0	1	01	01	H5410_032_0	7		N	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.70	19	19	19				37.36	18	18	18										19	19	19				18	18	18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	032	0	1	01	01	H5410_032_0	7		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.53	39	39	39				87.04	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	032	0	1	01	01	H5410_032_0	7		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											427.79	25						371.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	033	0	1	01	01	H5410_033_0	7		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					2.00	4.00	4.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.07		0.60	0.00	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	033	0	1	01	01	H5410_033_0	7		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	033	0	1	01	01	H5410_033_0	7		N	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.70	19	19	19				37.36	18	18	18										19	19	19				18	18	18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	033	0	1	01	01	H5410_033_0	7		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.53	39	39	39				87.04	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	033	0	1	01	01	H5410_033_0	7		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											427.79	25						371.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	034	0	1	01	01	H5410_034_0	7		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					2.00	4.00	4.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.07		0.60	0.00	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	034	0	1	01	01	H5410_034_0	7		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	034	0	1	01	01	H5410_034_0	7		N	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.70	19	19	19				37.36	18	18	18										19	19	19				18	18	18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	034	0	1	01	01	H5410_034_0	7		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.53	39	39	39				87.04	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	034	0	1	01	01	H5410_034_0	7		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											427.79	25						371.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_0	7		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					2.00	4.00	4.00											18.00	36.00	54.00				0.00	0.00	0.00				18.00				18.00			0.60	0.07		0.60	0.00	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_0	7		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	30.00											20.00	40.00	60.00				15.00	30.00	30.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_0	7		N	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											43.70	19	19	19				37.36	18	18	18										19	19	19				18	18	18			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_0	7		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.53	39	39	39				87.04	39	39	39										39	39	39				39	39	39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	035	0	1	01	01	H5410_035_0	7		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31											427.79	25						371.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	036	0	1	01	01	H5410_036_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	036	0	1	01	01	H5410_036_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	036	0	1	01	01	H5410_036_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	036	0	1	01	01	H5410_036_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	036	0	1	01	01	H5410_036_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.92	33						688.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	001	0	1	01	01	H5420_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	001	0	1	01	01	H5420_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	30.00		90.00																											90.00						80.00				30.00				30.00		1.00						0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	65.00		195.00																											195.00						185.00				65.00				65.00		2.16						2.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				332.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	3		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	003	0	1	01	01	H5420_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	003	0	1	01	01	H5420_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				389.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	3		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	006	0	1	01	01	H5420_006_0	3		N	Generic	4	01	3	2	2	1	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	3		N	Generic	4	01	3	2	2	3	110		01	100		1	30		100				2	2			100				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	006	0	1	01	01	H5420_006_0	3		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		100				2	2			100				30		31				43.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		100				2	2			100				30		31				52.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				267.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5422	007	0	1	01	01	H5422_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	007	0	1	01	01	H5422_007_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								42.00	84.00	126.00					42.00	84.00	126.00					42.00	126.00	126.00																42.00				42.00			1.40	1.40	1.40			1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	008	0	1	01	01	H5422_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	011	0	1	01	01	H5422_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								16.00	32.00	48.00					11.00	22.00	33.00					11.00	22.00	22.00																16.00				16.00			0.53	0.37	0.37			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	011	0	1	01	01	H5422_011_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	013	0	1	01	01	H5422_013_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5422	013	0	1	01	01	H5422_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					10.00	20.00	30.00					10.00	30.00	30.00																10.00				10.00			0.33	0.33	0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	013	0	1	01	01	H5422_013_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	001	0	1	01	01	H5425_001_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					2.00	4.00	4.00											10.00	20.00	20.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					2.00	4.00	4.00											10.00	20.00	20.00				2.00	4.00	0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	001	0	1	01	01	H5425_001_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	001	0	1	01	01	H5425_001_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	004	0	1	01	01	H5425_004_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					3.00	6.00	6.00											12.00	24.00	24.00				3.00	6.00	0.00				12.00				12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					3.00	6.00	6.00											12.00	24.00	24.00				3.00	6.00	0.00				12.00				12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	004	0	1	01	01	H5425_004_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	004	0	1	01	01	H5425_004_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	7		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	7		N	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	005	0	1	01	01	H5425_005_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	005	0	1	01	01	H5425_005_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	9		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	9		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	006	0	1	01	01	H5425_006_0	9		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	9		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	006	0	1	01	01	H5425_006_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	006	0	1	01	01	H5425_006_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	007	0	1	01	01	H5425_007_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	007	0	1	01	01	H5425_007_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	007	0	1	01	01	H5425_007_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	008	0	1	01	01	H5425_008_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					7.00	14.00	14.00											15.00	30.00	30.00				7.00	14.00	0.00				15.00				15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					7.00	14.00	14.00											15.00	30.00	30.00				7.00	14.00	0.00				15.00				15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	008	0	1	01	01	H5425_008_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	008	0	1	01	01	H5425_008_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	009	0	1	01	01	H5425_009_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					7.00	14.00	14.00											15.00	30.00	30.00				7.00	14.00	0.00				15.00				15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					7.00	14.00	14.00											15.00	30.00	30.00				7.00	14.00	0.00				15.00				15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	009	0	1	01	01	H5425_009_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	009	0	1	01	01	H5425_009_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	010	0	1	01	01	H5425_010_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	010	0	1	01	01	H5425_010_0	8		N	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	010	0	1	01	01	H5425_010_0	8		N	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											5.41	25	25	25				5.41	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	010	0	1	01	01	H5425_010_0	8		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											70.02	25	25	25				70.02	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	010	0	1	01	01	H5425_010_0	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											64.80	25	25	25				64.80	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	010	0	1	01	01	H5425_010_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					5.00	10.00	10.00											12.00	24.00	24.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	019	0	1	01	01	H5425_019_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					3.00	6.00	6.00											10.00	20.00	20.00				3.00	6.00	0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_0	8		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					5.00	10.00	10.00											12.00	24.00	24.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	020	0	1	01	01	H5425_020_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	028	0	1	01	01	H5425_028_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					2.00	4.00	4.00											9.00	18.00	18.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					2.00	4.00	4.00											9.00	18.00	18.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	028	0	1	01	01	H5425_028_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	028	0	1	01	01	H5425_028_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	030	0	1	01	01	H5425_030_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	030	0	1	01	01	H5425_030_0	7		N	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	030	0	1	01	01	H5425_030_0	7		N	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											5.58	25	25	25				5.58	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	030	0	1	01	01	H5425_030_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											62.28	25	25	25				62.28	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	030	0	1	01	01	H5425_030_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											50.32	25	25	25				50.32	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	030	0	1	01	01	H5425_030_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	033	0	1	01	01	H5425_033_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					7.00	14.00	14.00											14.00	28.00	28.00				7.00	14.00	0.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					7.00	14.00	14.00											14.00	28.00	28.00				7.00	14.00	0.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	033	0	1	01	01	H5425_033_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	033	0	1	01	01	H5425_033_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	034	0	1	01	01	H5425_034_0	8		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					2.00	4.00	4.00											9.00	18.00	18.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	8		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								9.00	18.00	18.00					2.00	4.00	4.00											9.00	18.00	18.00				2.00	4.00	0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	034	0	1	01	01	H5425_034_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								35.00	70.00	85.00					30.00	60.00	70.00											35.00	70.00	85.00				30.00	60.00	70.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	034	0	1	01	01	H5425_034_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	040	0	1	01	01	H5425_040_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	040	0	1	01	01	H5425_040_0	7		N	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											6.12	25	25	25				6.12	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	040	0	1	01	01	H5425_040_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											68.45	25	25	25				68.45	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	040	0	1	01	01	H5425_040_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											61.70	25	25	25				61.70	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	040	0	1	01	01	H5425_040_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	045	0	1	01	01	H5425_045_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	18.00				0.00	0.00	0.00				6.00				6.00			0.20	0.00		0.20	0.00	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	045	0	1	01	01	H5425_045_0	8		N	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											6.13	25	25	25				6.13	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	045	0	1	01	01	H5425_045_0	8		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											67.04	25	25	25				67.04	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	045	0	1	01	01	H5425_045_0	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											61.37	25	25	25				61.37	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	045	0	1	01	01	H5425_045_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	34.00					10.00	20.00	20.00											17.00	34.00	34.00				10.00	20.00	0.00				17.00				17.00			0.57	0.33		0.57	0.33	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	052	0	1	01	01	H5425_052_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		N	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	053	0	1	01	01	H5425_053_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	34.00					10.00	20.00	20.00											17.00	34.00	34.00				10.00	20.00	0.00				17.00				17.00			0.57	0.33		0.57	0.33	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	053	0	1	01	01	H5425_053_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	5		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	054	0	1	01	01	H5425_054_0	5		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.00	34.00	34.00					10.00	20.00	20.00											17.00	34.00	34.00				10.00	20.00	0.00				17.00				17.00			0.57	0.33		0.57	0.33	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	054	0	1	01	01	H5425_054_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		N	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	055	0	1	01	01	H5425_055_0	8		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					5.00	10.00	10.00											12.00	24.00	24.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	055	0	1	01	01	H5425_055_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	064	0	1	01	01	H5425_064_0	7		N	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	064	0	1	01	01	H5425_064_0	7		N	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	064	0	1	01	01	H5425_064_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					7.00	14.00	14.00											15.00	30.00	30.00				7.00	14.00	0.00				15.00				15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	064	0	1	01	01	H5425_064_0	7		N	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					7.00	14.00	14.00											15.00	30.00	30.00				7.00	14.00	0.00				15.00				15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	064	0	1	01	01	H5425_064_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	064	0	1	01	01	H5425_064_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	064	0	1	01	01	H5425_064_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	065	0	1	01	01	H5425_065_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					5.00	10.00	10.00											12.00	24.00	24.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					5.00	10.00	10.00											12.00	24.00	24.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	065	0	1	01	01	H5425_065_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	065	0	1	01	01	H5425_065_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	066	0	1	01	01	H5425_066_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					5.00	10.00	10.00											12.00	24.00	24.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	24.00					5.00	10.00	10.00											12.00	24.00	24.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	066	0	1	01	01	H5425_066_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	066	0	1	01	01	H5425_066_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	067	0	1	01	01	H5425_067_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					7.00	14.00	14.00											14.00	28.00	28.00				7.00	14.00	0.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					7.00	14.00	14.00											14.00	28.00	28.00				7.00	14.00	0.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	067	0	1	01	01	H5425_067_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	067	0	1	01	01	H5425_067_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	7		Y	Preferred Generic	4	11	3	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	7		Y	Preferred Generic	4	11	3	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	14.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5425	068	0	1	01	01	H5425_068_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					7.00	14.00	14.00											14.00	28.00	28.00				7.00	14.00	0.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								14.00	28.00	28.00					7.00	14.00	14.00											14.00	28.00	28.00				7.00	14.00	0.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	068	0	1	01	01	H5425_068_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					37.00	74.00	91.00											47.00	94.00	121.00				37.00	74.00	91.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	068	0	1	01	01	H5425_068_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	069	0	1	01	01	H5425_069_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	069	0	1	01	01	H5425_069_0	7		N	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	069	0	1	01	01	H5425_069_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					9.00	18.00	18.00											15.00	30.00	30.00				9.00	18.00	0.00				15.00				15.00			0.50	0.30		0.50	0.30	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	069	0	1	01	01	H5425_069_0	7		N	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					9.00	18.00	18.00											15.00	30.00	30.00				9.00	18.00	0.00				15.00				15.00			0.50	0.30		0.50	0.30	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	069	0	1	01	01	H5425_069_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					40.00	80.00	100.00											47.00	94.00	121.00				40.00	80.00	100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	069	0	1	01	01	H5425_069_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					90.00	180.00	250.00											100.00	200.00	280.00				90.00	180.00	250.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	069	0	1	01	01	H5425_069_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	7		Y	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	10.00					0.00	0.00	0.00											5.00	10.00	10.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	070	0	1	01	01	H5425_070_0	7		Y	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					9.00	18.00	18.00											15.00	30.00	30.00				9.00	18.00	0.00				15.00				15.00			0.50	0.30		0.50	0.30	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	7		Y	Generic	4	11	1	2	2	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								15.00	30.00	30.00					9.00	18.00	18.00											15.00	30.00	30.00				9.00	18.00	0.00				15.00				15.00			0.50	0.30		0.50	0.30	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5425	070	0	1	01	01	H5425_070_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								45.00	90.00	115.00					30.00	60.00	70.00											45.00	90.00	115.00				30.00	60.00	70.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								95.00	190.00	265.00					85.00	170.00	235.00											95.00	190.00	265.00				85.00	170.00	235.00				95.00				95.00			3.17	2.83		3.17	2.83	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	070	0	1	01	01	H5425_070_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	071	0	1	01	01	H5425_071_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	071	0	1	01	01	H5425_071_0	7		N	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											6.13	25	25	25				6.13	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	071	0	1	01	01	H5425_071_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											67.03	25	25	25				67.03	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	071	0	1	01	01	H5425_071_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											61.28	25	25	25				61.28	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	071	0	1	01	01	H5425_071_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	072	0	1	01	01	H5425_072_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	072	0	1	01	01	H5425_072_0	7		N	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											6.13	25	25	25				6.13	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	072	0	1	01	01	H5425_072_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											67.03	25	25	25				67.03	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	072	0	1	01	01	H5425_072_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											61.28	25	25	25				61.28	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	072	0	1	01	01	H5425_072_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	073	0	1	01	01	H5425_073_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					5.00	10.00	10.00											10.00	20.00	20.00				5.00	10.00	0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	073	0	1	01	01	H5425_073_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								17.50	35.00	35.00					12.50	25.00	25.00											17.50	35.00	35.00				12.50	25.00	0.00				17.50				17.50			0.58	0.42		0.58	0.42	0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	073	0	1	01	01	H5425_073_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								45.00	90.00	115.00					40.00	80.00	100.00											45.00	90.00	115.00				40.00	80.00	100.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	073	0	1	01	01	H5425_073_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								95.00	190.00	265.00					90.00	180.00	250.00											95.00	190.00	265.00				90.00	180.00	250.00				95.00				95.00			3.17	3.00		3.17	3.00	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	073	0	1	01	01	H5425_073_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	074	0	1	01	01	H5425_074_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								10.00	20.00	20.00					5.00	10.00	10.00											10.00	20.00	20.00				5.00	10.00	0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	074	0	1	01	01	H5425_074_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								20.00	40.00	40.00					15.00	30.00	30.00											20.00	40.00	40.00				15.00	30.00	0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	074	0	1	01	01	H5425_074_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	121.00					42.00	84.00	106.00											47.00	94.00	121.00				42.00	84.00	106.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	074	0	1	01	01	H5425_074_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	280.00					95.00	190.00	265.00											100.00	200.00	280.00				95.00	190.00	265.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5425	074	0	1	01	01	H5425_074_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	059	0	1	01	01	H5427_059_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	060	0	1	01	01	H5427_060_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	070	0	1	01	01	H5427_070_0	6		Y	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H5427	072	0	1	01	01	H5427_072_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	072	0	1	01	01	H5427_072_0	6		Y	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H5427	077	0	1	01	01	H5427_077_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	077	0	1	01	01	H5427_077_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	078	0	1	01	01	H5427_078_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	082	0	1	01	01	H5427_082_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	6		N	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	083	0	1	01	01	H5427_083_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	083	0	1	01	01	H5427_083_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	088	0	1	01	01	H5427_088_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	089	0	1	01	01	H5427_089_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	091	0	1	01	01	H5427_091_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	092	0	1	01	01	H5427_092_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	093	0	1	01	01	H5427_093_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	094	0	1	01	01	H5427_094_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	70.00		210.00																			70.00		140.00																70.00				70.00		2.33			2.33			2.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	096	0	1	01	01	H5427_096_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	098	0	1	01	01	H5427_098_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	098	0	1	01	01	H5427_098_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	098	0	1	01	01	H5427_098_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	098	0	1	01	01	H5427_098_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	098	0	1	01	01	H5427_098_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	099	0	1	01	01	H5427_099_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	099	0	1	01	01	H5427_099_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.65	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	099	0	1	01	01	H5427_099_0	6		N	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	102	0	1	01	01	H5427_102_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	102	0	1	01	01	H5427_102_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	102	0	1	01	01	H5427_102_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	102	0	1	01	01	H5427_102_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	103	0	1	01	01	H5427_103_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	103	0	1	01	01	H5427_103_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	103	0	1	01	01	H5427_103_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	103	0	1	01	01	H5427_103_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.15	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5431	001	0	1	01	01	H5431_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	001	0	1	01	01	H5431_001_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H5431	001	0	1	01	01	H5431_001_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	001	0	1	01	01	H5431_001_0	7		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H5431	001	0	1	01	01	H5431_001_0	7		N	Preferred Brand	4	10	1	2	3	1		010	01	010		1				30					30						30		34								20.00							0.00							0.00																		20.00				20.00			0.67	0.00	0.00			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	001	0	1	01	01	H5431_001_0	7		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								35.00							25.00							25.00																		35.00				35.00			1.17	0.83	0.83			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	001	0	1	01	01	H5431_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	001	0	1	01	01	H5431_001_0	7		N	Supplemental Drugs	4	11	2	2	6	1		010	01	010		1				30					30						30		34								0.00							0.00							0.00																		0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	006	0	1	01	01	H5431_006_0	7		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				1.94	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	006	0	1	01	01	H5431_006_0	7		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				10.13	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	006	0	1	01	01	H5431_006_0	7		N	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				84.16	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	006	0	1	01	01	H5431_006_0	7		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				33.69	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	006	0	1	01	01	H5431_006_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	006	0	1	01	01	H5431_006_0	7		N	Supplemental Drugs	4	11	2	2	6	1	010		01	010		1	30								30						30		34	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	012	0	1	01	01	H5431_012_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	012	0	1	01	01	H5431_012_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H5431	012	0	1	01	01	H5431_012_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	012	0	1	01	01	H5431_012_0	7		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H5431	012	0	1	01	01	H5431_012_0	7		N	Preferred Brand	4	10	1	2	3	1		010	01	010		1				30					30						30		34								20.00							15.00							15.00																		20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	012	0	1	01	01	H5431_012_0	7		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								35.00							30.00							30.00																		35.00				35.00			1.17	1.00	1.00			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	012	0	1	01	01	H5431_012_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	012	0	1	01	01	H5431_012_0	7		N	Supplemental Drugs	4	11	2	2	6	1		010	01	010		1				30					30						30		34								0.00							0.00							0.00																		0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H5431	013	0	1	01	01	H5431_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H5431	013	0	1	01	01	H5431_013_0	6		N	Preferred Brand	4	10	1	2	3	1		010	01	010		1				30					30						30		34								20.00							15.00							15.00																		20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								35.00							30.00							30.00																		35.00				35.00			1.17	1.00	1.00			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	013	0	1	01	01	H5431_013_0	6		N	Supplemental Drugs	4	11	2	2	6	1		010	01	010		1				30					30						30		34								0.00							0.00							0.00																		0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	014	0	1	01	01	H5431_014_0	6		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				2.01	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	014	0	1	01	01	H5431_014_0	6		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				10.48	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	014	0	1	01	01	H5431_014_0	6		N	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				87.24	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	014	0	1	01	01	H5431_014_0	6		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				34.71	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	014	0	1	01	01	H5431_014_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	014	0	1	01	01	H5431_014_0	6		N	Supplemental Drugs	4	11	2	2	6	1	010		01	010		1	30								30						30		34	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	015	0	1	01	01	H5431_015_0	6		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				1.94	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	015	0	1	01	01	H5431_015_0	6		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				10.13	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	015	0	1	01	01	H5431_015_0	6		N	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				84.16	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	015	0	1	01	01	H5431_015_0	6		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				33.73	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	015	0	1	01	01	H5431_015_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	015	0	1	01	01	H5431_015_0	6		N	Supplemental Drugs	4	11	2	2	6	1	010		01	010		1	30								30						30		34	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				2.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				10.50	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Preferred Brand	4	10	1	1	3	1	010		01	010		1	30								30						30		34				86.98	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				34.78	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5431	016	0	1	01	01	H5431_016_0	6		N	Supplemental Drugs	4	11	2	2	6	1	010		01	010		1	30								30						30		34	0.00																					0.00																		0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H5433	001	0	1	01	01	H5433_001_0	5		N	Generic	4	11	1	2	1	1	111		01			1	30	60	90				2	2							30		31	0.00	0.00	0.00																																					0.00				0.00									Generic, Brand												
H5433	001	0	1	01	01	H5433_001_0	5		N	Generic	4	11	1	2	1	3	111		01			1	30	60	90				2	2							30		31	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Generic, Brand										1		
H5433	001	0	1	01	01	H5433_001_0	5		N	Brand	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		31	0.00	0.00	0.00																																					0.00				0.00									Generic, Brand												
H5434	002	0	1	04	01	H5434_002_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	002	0	1	04	01	H5434_002_0	8		Y	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	002	0	1	04	01	H5434_002_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	002	0	1	04	01	H5434_002_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	002	0	1	04	01	H5434_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	002	0	1	04	01	H5434_002_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											790.65	27						790.65	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	002	0	1	04	01	H5434_002_0	8		Y	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	002	0	1	04	01	H5434_002_0	8		Y	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	023	0	1	04	01	H5434_023_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	023	0	1	04	01	H5434_023_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	8.00		24.00																			8.00		24.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1016.16	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	023	0	1	04	01	H5434_023_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	024	0	1	04	01	H5434_024_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	024	0	1	04	01	H5434_024_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	8.00		24.00																			8.00		24.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1024.90	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	024	0	1	04	01	H5434_024_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	025	0	1	04	01	H5434_025_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	7		Y	Preferred Generic	4	01	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	025	0	1	04	01	H5434_025_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	8.00		24.00																			8.00		24.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1118.40	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	025	0	1	04	01	H5434_025_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	026	0	1	04	01	H5434_026_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	026	0	1	04	01	H5434_026_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	8.00		24.00																			8.00		24.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	026	0	1	04	01	H5434_026_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	026	0	1	04	01	H5434_026_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	026	0	1	04	01	H5434_026_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1029.20	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	026	0	1	04	01	H5434_026_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	026	0	1	04	01	H5434_026_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	030	0	1	04	01	H5434_030_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	030	0	1	04	01	H5434_030_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	8.00		24.00																			8.00		24.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	030	0	1	04	01	H5434_030_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	030	0	1	04	01	H5434_030_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	030	0	1	04	01	H5434_030_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1024.68	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	030	0	1	04	01	H5434_030_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	030	0	1	04	01	H5434_030_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	031	0	1	04	01	H5434_031_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	8.00		24.00																			8.00		24.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1010.58	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	031	0	1	04	01	H5434_031_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	032	0	1	04	01	H5434_032_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	2.00		6.00																			2.00		6.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	032	0	1	04	01	H5434_032_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	032	0	1	04	01	H5434_032_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	032	0	1	04	01	H5434_032_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	032	0	1	04	01	H5434_032_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1117.47	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	032	0	1	04	01	H5434_032_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	032	0	1	04	01	H5434_032_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	033	0	1	04	01	H5434_033_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	3.00		9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	033	0	1	04	01	H5434_033_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	12.00		36.00																			12.00		36.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	033	0	1	04	01	H5434_033_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	033	0	1	04	01	H5434_033_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	033	0	1	04	01	H5434_033_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1008.71	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	033	0	1	04	01	H5434_033_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	033	0	1	04	01	H5434_033_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	034	0	1	04	01	H5434_034_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	3.00		9.00																			3.00		9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	034	0	1	04	01	H5434_034_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	12.00		36.00																			12.00		36.00																12.00				12.00		0.39			0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	034	0	1	04	01	H5434_034_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	034	0	1	04	01	H5434_034_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	034	0	1	04	01	H5434_034_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1008.42	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	034	0	1	04	01	H5434_034_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	034	0	1	04	01	H5434_034_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	035	0	1	04	01	H5434_035_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	035	0	1	04	01	H5434_035_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	035	0	1	04	01	H5434_035_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	035	0	1	04	01	H5434_035_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	035	0	1	04	01	H5434_035_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				990.30	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	035	0	1	04	01	H5434_035_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	035	0	1	04	01	H5434_035_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5434	036	0	1	04	01	H5434_036_0	7		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	036	0	1	04	01	H5434_036_0	7		Y	Generic	4	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	8.00		24.00																			8.00		24.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	036	0	1	04	01	H5434_036_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	036	0	1	04	01	H5434_036_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	31		90				1	2	31		90				31		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	036	0	1	04	01	H5434_036_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				1007.76	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	036	0	1	04	01	H5434_036_0	7		Y	Select Care Drugs	4	01	1	2	6	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5434	036	0	1	04	01	H5434_036_0	7		Y	Select Care Drugs	4	01	1	2	6	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5435	024	0	1	09	04	H5435_024_0	5			Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	5			Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	5			Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5435	024	0	1	09	04	H5435_024_0	5			Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	5			Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	5			Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				293.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5439	011	0	1	04	01	H5439_011_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	20.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	31						0.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	011	0	1	04	01	H5439_011_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	29						0.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	015	0	1	04	01	H5439_015_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	4		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	30						0.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	017	0	1	04	01	H5439_017_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	30						0.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	018	0	1	04	01	H5439_018_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	30						0.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5439	019	0	1	04	01	H5439_019_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5447	001	0	1	01	01	H5447_001_0	6		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	001	0	1	01	01	H5447_001_0	6		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	7.00	14.00	17.50																			7.00	14.00	17.50																	7.00			7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	001	0	1	01	01	H5447_001_0	6		N	Preferred Brand	4	10	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	30.00	60.00	75.00																			30.00	60.00	75.00																	30.00			30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	001	0	1	01	01	H5447_001_0	6		N	Non-Preferred Brand	4	10	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				98.00	30	30	30																		30	30	30																30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	001	0	1	01	01	H5447_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							29	31				1760.00	27																				27																		27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Preferred Generic	3	01	1	1	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				5.00	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Generic	3	01	1	1	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				15.00	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Preferred Brand	3	10	1	1	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				95.00	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Non-Preferred Brand	3	10	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				130.00	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5447	002	0	1	01	01	H5447_002_0	5		N	Specialty Tier	3	11	1	1	5	1	010		10	010		1	30								30							29	31				1160.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	6		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	6		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					12.00		36.00											19.00		57.00				12.00		36.00				19.00				19.00			0.63	0.40		0.63	0.40	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	6		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	6		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	001	0	1	01	01	H5454_001_0	6		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												33		33					33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	6		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	6		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					12.00		36.00											19.00		57.00				12.00		36.00				19.00				19.00			0.63	0.40		0.63	0.40	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	6		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	6		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5454	002	0	1	01	01	H5454_002_0	6		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												33		33					33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	064	0	1	01	01	H5471_064_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	5		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	064	0	1	01	01	H5471_064_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	064	0	1	01	01	H5471_064_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	065	0	1	01	01	H5471_065_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	065	0	1	01	01	H5471_065_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	5.00																					5.00																		5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	065	0	1	01	01	H5471_065_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	066	0	1	01	01	H5471_066_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	5		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	066	0	1	01	01	H5471_066_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	066	0	1	01	01	H5471_066_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	4.00	8.00	12.00																																					4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				64.34	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				93.47	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	067	0	1	01	01	H5471_067_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	068	0	1	01	01	H5471_068_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				59.31	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				93.34	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	068	0	1	01	01	H5471_068_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	069	0	1	01	01	H5471_069_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	069	0	1	01	01	H5471_069_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_0	5		N	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	069	0	1	01	01	H5471_069_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	10.00																					10.00																		10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	069	0	1	01	01	H5471_069_0	5		N	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	10.00																					10.00																		10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	069	0	1	01	01	H5471_069_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	070	0	1	01	01	H5471_070_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	070	0	1	01	01	H5471_070_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	070	0	1	01	01	H5471_070_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	070	0	1	01	01	H5471_070_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	070	0	1	01	01	H5471_070_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	070	0	1	01	01	H5471_070_0	5		N	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	070	0	1	01	01	H5471_070_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	40.00																					40.00																		40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	070	0	1	01	01	H5471_070_0	5		N	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	40.00																					40.00																		40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	070	0	1	01	01	H5471_070_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	071	0	1	01	01	H5471_071_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	071	0	1	01	01	H5471_071_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			10.00	30.00	30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	55.00																					55.00																		55.00				55.00		1.83			1.83			1.62	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	071	0	1	01	01	H5471_071_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	072	0	1	01	01	H5471_072_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	5		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	072	0	1	01	01	H5471_072_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	072	0	1	01	01	H5471_072_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	073	0	1	01	01	H5471_073_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	073	0	1	01	01	H5471_073_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	073	0	1	01	01	H5471_073_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	073	0	1	01	01	H5471_073_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	073	0	1	01	01	H5471_073_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	073	0	1	01	01	H5471_073_0	5		N	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	073	0	1	01	01	H5471_073_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	073	0	1	01	01	H5471_073_0	5		N	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	073	0	1	01	01	H5471_073_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	074	0	1	01	01	H5471_074_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	074	0	1	01	01	H5471_074_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	074	0	1	01	01	H5471_074_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	075	0	1	01	01	H5471_075_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	075	0	1	01	01	H5471_075_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	075	0	1	01	01	H5471_075_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	075	0	1	01	01	H5471_075_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	075	0	1	01	01	H5471_075_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	075	0	1	01	01	H5471_075_0	5		N	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	075	0	1	01	01	H5471_075_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	075	0	1	01	01	H5471_075_0	5		N	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	075	0	1	01	01	H5471_075_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	076	0	1	01	01	H5471_076_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	5		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	076	0	1	01	01	H5471_076_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	076	0	1	01	01	H5471_076_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	077	0	1	01	01	H5471_077_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	077	0	1	01	01	H5471_077_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	25.00	50.00	75.00																			25.00	75.00	75.00																25.00				25.00		0.83			0.83			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	077	0	1	01	01	H5471_077_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	078	0	1	01	01	H5471_078_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	078	0	1	01	01	H5471_078_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	078	0	1	01	01	H5471_078_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	079	0	1	01	01	H5471_079_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	4.00	8.00	12.00																																					4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	079	0	1	01	01	H5471_079_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	079	0	1	01	01	H5471_079_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				63.38	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	079	0	1	01	01	H5471_079_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				93.34	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	079	0	1	01	01	H5471_079_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	080	0	1	01	01	H5471_080_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	080	0	1	01	01	H5471_080_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	5		N	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	080	0	1	01	01	H5471_080_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	080	0	1	01	01	H5471_080_0	5		N	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	080	0	1	01	01	H5471_080_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	081	0	1	01	01	H5471_081_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	081	0	1	01	01	H5471_081_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	081	0	1	01	01	H5471_081_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	081	0	1	01	01	H5471_081_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				63.80	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	081	0	1	01	01	H5471_081_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				92.62	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	081	0	1	01	01	H5471_081_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	082	0	1	01	01	H5471_082_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	5		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	082	0	1	01	01	H5471_082_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	082	0	1	01	01	H5471_082_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	083	0	1	01	01	H5471_083_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	083	0	1	01	01	H5471_083_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	60.00	60.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	083	0	1	01	01	H5471_083_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	5		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	100	2	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	084	0	1	01	01	H5471_084_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	5		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	084	0	1	01	01	H5471_084_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	5		N	Non-Preferred Brand	4	10	1	2	4	1		010	01	010		1				30					30						30		34								100.00							95.00							95.00																		100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	084	0	1	01	01	H5471_084_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	085	0	1	01	01	H5471_085_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	085	0	1	01	01	H5471_085_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	5		N	Preferred Brand	4	10	1	2	3	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	085	0	1	01	01	H5471_085_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	085	0	1	01	01	H5471_085_0	5		N	Non-Preferred Brand	4	10	1	2	4	3	010		01	010		1	30								30						30		34	75.00																					75.00																		75.00				75.00		2.50			2.50			2.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	085	0	1	01	01	H5471_085_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	090	0	1	01	01	H5471_090_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	090	0	1	01	01	H5471_090_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	090	0	1	01	01	H5471_090_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	090	0	1	01	01	H5471_090_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				61.56	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	090	0	1	01	01	H5471_090_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				90.79	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	090	0	1	01	01	H5471_090_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	091	0	1	01	01	H5471_091_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	091	0	1	01	01	H5471_091_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	091	0	1	01	01	H5471_091_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	091	0	1	01	01	H5471_091_0	5		N	Generic	4	11	1	2	2	3	111		01			1	30	60	90				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	091	0	1	01	01	H5471_091_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01			1	30	60	90				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	091	0	1	01	01	H5471_091_0	5		N	Preferred Brand	4	10	1	2	3	3	111		01			1	30	60	90				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	091	0	1	01	01	H5471_091_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				90.78	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	091	0	1	01	01	H5471_091_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	4.00	8.00	12.00																																					4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				62.34	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				91.95	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	092	0	1	01	01	H5471_092_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	093	0	1	01	01	H5471_093_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				63.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				91.81	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	093	0	1	01	01	H5471_093_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	094	0	1	01	01	H5471_094_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	4.00	8.00	12.00																																					4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	094	0	1	01	01	H5471_094_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	094	0	1	01	01	H5471_094_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				62.59	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	094	0	1	01	01	H5471_094_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				92.26	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	094	0	1	01	01	H5471_094_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	095	0	1	01	01	H5471_095_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	095	0	1	01	01	H5471_095_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	095	0	1	01	01	H5471_095_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	095	0	1	01	01	H5471_095_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				63.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	095	0	1	01	01	H5471_095_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				92.51	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	095	0	1	01	01	H5471_095_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	096	0	1	01	01	H5471_096_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	4.00	8.00	12.00																																					4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	096	0	1	01	01	H5471_096_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	6.00	12.00	18.00																																					6.00				6.00		0.20						0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	096	0	1	01	01	H5471_096_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				65.64	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	096	0	1	01	01	H5471_096_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				95.86	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	096	0	1	01	01	H5471_096_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	097	0	1	01	01	H5471_097_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	097	0	1	01	01	H5471_097_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01			1	30	60	100				2	2							30		34	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	097	0	1	01	01	H5471_097_0	5		N	Generic	4	11	1	2	2	1	111		01			1	30	60	90				2	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	097	0	1	01	01	H5471_097_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01			1	30	60	90				2	2							30		34				66.00	25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	097	0	1	01	01	H5471_097_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01			1	30														30		34				95.82	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	097	0	1	01	01	H5471_097_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		34					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	098	0	1	01	01	H5471_098_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	098	0	1	01	01	H5471_098_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	098	0	1	01	01	H5471_098_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	098	0	1	01	01	H5471_098_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	098	0	1	01	01	H5471_098_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				69.37	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	098	0	1	01	01	H5471_098_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				110.37	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	098	0	1	01	01	H5471_098_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	099	0	1	01	01	H5471_099_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	099	0	1	01	01	H5471_099_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	099	0	1	01	01	H5471_099_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	099	0	1	01	01	H5471_099_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	099	0	1	01	01	H5471_099_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				70.23	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	099	0	1	01	01	H5471_099_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				93.34	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	099	0	1	01	01	H5471_099_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	100	0	1	01	01	H5471_100_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	100	0	1	01	01	H5471_100_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	100	0	1	01	01	H5471_100_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	100	0	1	01	01	H5471_100_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	100	0	1	01	01	H5471_100_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				68.47	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	100	0	1	01	01	H5471_100_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				109.87	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	100	0	1	01	01	H5471_100_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	101	0	1	01	01	H5471_101_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	101	0	1	01	01	H5471_101_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	101	0	1	01	01	H5471_101_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	101	0	1	01	01	H5471_101_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	101	0	1	01	01	H5471_101_0	5		N	Preferred Brand	4	10	1	1	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34				70.13	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	101	0	1	01	01	H5471_101_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	010		01	010		1	30								30						30		34				113.70	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	101	0	1	01	01	H5471_101_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	103	0	1	01	01	H5471_103_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			10.00	30.00	30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	10.00	20.00	30.00																			10.00	30.00	30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	103	0	1	01	01	H5471_103_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	103	0	1	01	01	H5471_103_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	104	0	1	01	01	H5471_104_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	60.00	60.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	60.00	60.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	104	0	1	01	01	H5471_104_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	104	0	1	01	01	H5471_104_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	5		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	100				2	2	30	60	100				30		34	10.00	20.00	30.00																			10.00	30.00	30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	5		N	Preferred Generic	4	01	3	2	1	3	111		01	111		1	30	60	100				2	2	30	60	100				30		34	10.00	20.00	30.00																			10.00	30.00	30.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	105	0	1	01	01	H5471_105_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	60.00	60.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	5		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	20.00	40.00	60.00																			20.00	60.00	60.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	105	0	1	01	01	H5471_105_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	47.00	94.00	141.00																			47.00	141.00	141.00																47.00				47.00		1.57			1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	5		N	Non-Preferred Brand	4	10	1	2	4	1	010		01	010		1	30								30						30		34	100.00																					100.00																		100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	105	0	1	01	01	H5471_105_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	001	0	1	02	01	H5475_001_0	7		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	001	0	1	02	01	H5475_001_0	7		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	001	0	1	02	01	H5475_001_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	001	0	1	02	01	H5475_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.13	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	001	0	1	02	01	H5475_001_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	003	0	1	02	01	H5475_003_0	7		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	003	0	1	02	01	H5475_003_0	7		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	003	0	1	02	01	H5475_003_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	003	0	1	02	01	H5475_003_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	003	0	1	02	01	H5475_003_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	004	0	1	02	01	H5475_004_0	7		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	004	0	1	02	01	H5475_004_0	7		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	004	0	1	02	01	H5475_004_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	004	0	1	02	01	H5475_004_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.15	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	004	0	1	02	01	H5475_004_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	005	0	1	02	01	H5475_005_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	005	0	1	02	01	H5475_005_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.6				0.6	0.6	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	005	0	1	02	01	H5475_005_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	005	0	1	02	01	H5475_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	005	0	1	02	01	H5475_005_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	006	0	1	02	01	H5475_006_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	006	0	1	02	01	H5475_006_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	006	0	1	02	01	H5475_006_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	006	0	1	02	01	H5475_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	006	0	1	02	01	H5475_006_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	010	0	1	02	01	H5475_010_0	7		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	010	0	1	02	01	H5475_010_0	7		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	010	0	1	02	01	H5475_010_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	010	0	1	02	01	H5475_010_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.21	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	010	0	1	02	01	H5475_010_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	011	0	1	02	01	H5475_011_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	011	0	1	02	01	H5475_011_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	011	0	1	02	01	H5475_011_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	011	0	1	02	01	H5475_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	011	0	1	02	01	H5475_011_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	019	0	1	02	01	H5475_019_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	019	0	1	02	01	H5475_019_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	019	0	1	02	01	H5475_019_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	019	0	1	02	01	H5475_019_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	019	0	1	02	01	H5475_019_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	021	0	1	02	01	H5475_021_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	021	0	1	02	01	H5475_021_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	021	0	1	02	01	H5475_021_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	021	0	1	02	01	H5475_021_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.21	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	021	0	1	02	01	H5475_021_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	022	0	1	02	01	H5475_022_0	7		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	022	0	1	02	01	H5475_022_0	7		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	022	0	1	02	01	H5475_022_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	022	0	1	02	01	H5475_022_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	022	0	1	02	01	H5475_022_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	024	0	1	02	01	H5475_024_0	8		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	024	0	1	02	01	H5475_024_0	8		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	024	0	1	02	01	H5475_024_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	024	0	1	02	01	H5475_024_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	024	0	1	02	01	H5475_024_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	026	0	1	02	01	H5475_026_0	7		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	026	0	1	02	01	H5475_026_0	7		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	026	0	1	02	01	H5475_026_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	026	0	1	02	01	H5475_026_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	026	0	1	02	01	H5475_026_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	029	0	1	02	01	H5475_029_0	7		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	029	0	1	02	01	H5475_029_0	7		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5475	029	0	1	02	01	H5475_029_0	7		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	029	0	1	02	01	H5475_029_0	7		Y	Generic	4	11	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5475	029	0	1	02	01	H5475_029_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	029	0	1	02	01	H5475_029_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	029	0	1	02	01	H5475_029_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	029	0	1	02	01	H5475_029_0	7		Y	Select Care Drugs	4	11	1	2	6	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5475	029	0	1	02	01	H5475_029_0	7		Y	Select Care Drugs	4	11	1	2	6	3	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
H5475	030	0	1	02	01	H5475_030_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	030	0	1	02	01	H5475_030_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	030	0	1	02	01	H5475_030_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	030	0	1	02	01	H5475_030_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.44	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	030	0	1	02	01	H5475_030_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	031	0	1	01	01	H5475_031_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	031	0	1	01	01	H5475_031_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	031	0	1	01	01	H5475_031_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	031	0	1	01	01	H5475_031_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.27	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	031	0	1	01	01	H5475_031_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	032	0	1	01	01	H5475_032_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	032	0	1	01	01	H5475_032_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	032	0	1	01	01	H5475_032_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	032	0	1	01	01	H5475_032_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.27	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	032	0	1	01	01	H5475_032_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	033	0	1	01	01	H5475_033_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	033	0	1	01	01	H5475_033_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	033	0	1	01	01	H5475_033_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	033	0	1	01	01	H5475_033_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	033	0	1	01	01	H5475_033_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	034	0	1	01	01	H5475_034_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	034	0	1	01	01	H5475_034_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	034	0	1	01	01	H5475_034_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	034	0	1	01	01	H5475_034_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	034	0	1	01	01	H5475_034_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	035	0	1	02	01	H5475_035_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	035	0	1	02	01	H5475_035_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		0.00				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	035	0	1	02	01	H5475_035_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	035	0	1	02	01	H5475_035_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.71	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	035	0	1	02	01	H5475_035_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	036	0	1	02	01	H5475_036_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	036	0	1	02	01	H5475_036_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	036	0	1	02	01	H5475_036_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	036	0	1	02	01	H5475_036_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	036	0	1	02	01	H5475_036_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	037	0	1	02	01	H5475_037_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	037	0	1	02	01	H5475_037_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	037	0	1	02	01	H5475_037_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	037	0	1	02	01	H5475_037_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5475	037	0	1	02	01	H5475_037_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5496	005	0	1	01	01	H5496_005_0	8		Y	Generic	4	11	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5496	005	0	1	01	01	H5496_005_0	8		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1188.84	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	005	0	1	01	01	H5496_005_0	8		Y	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	3.00		6.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5496	007	0	1	01	01	H5496_007_0	8		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	007	0	1	01	01	H5496_007_0	8		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5496	007	0	1	01	01	H5496_007_0	8		N	Generic	4	11	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	007	0	1	01	01	H5496_007_0	8		N	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5496	007	0	1	01	01	H5496_007_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		110.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	007	0	1	01	01	H5496_007_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		225.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	007	0	1	01	01	H5496_007_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1216.35	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	7		N	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	7		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5496	009	0	1	01	01	H5496_009_0	7		N	Generic	4	11	3	1	2	1	110		01	100		1	30		90				1	2			90				30		31				9.71	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	7		N	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5496	009	0	1	01	01	H5496_009_0	7		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				78.31	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				73.44	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	009	0	1	01	01	H5496_009_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				633.24	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	7		N	Preferred Generic	4	11	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	7		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5496	011	0	1	01	01	H5496_011_0	7		N	Generic	4	11	3	1	2	1	110		01	100		1	30		90				1	2			90				30		31				9.69	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	7		N	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5496	011	0	1	01	01	H5496_011_0	7		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				78.09	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				73.30	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	011	0	1	01	01	H5496_011_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				633.12	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	012	0	1	01	01	H5496_012_0	8		N	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	012	0	1	01	01	H5496_012_0	8		N	Preferred Generic	4	11	1	1	1	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5496	012	0	1	01	01	H5496_012_0	8		N	Generic	4	11	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	3.00		6.00																					5.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	012	0	1	01	01	H5496_012_0	8		N	Generic	4	11	3	1	2	3	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5496	012	0	1	01	01	H5496_012_0	8		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	30.00		90.00																					75.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	012	0	1	01	01	H5496_012_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		200.00																					180.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5496	012	0	1	01	01	H5496_012_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				788.61	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	012	0	1	04	01	H5521_012_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	012	0	1	04	01	H5521_012_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	012	0	1	04	01	H5521_012_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	012	0	1	04	01	H5521_012_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	012	0	1	04	01	H5521_012_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	012	0	1	04	01	H5521_012_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											794.19	33						562.45	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	013	0	1	04	01	H5521_013_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	013	0	1	04	01	H5521_013_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	013	0	1	04	01	H5521_013_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	013	0	1	04	01	H5521_013_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	013	0	1	04	01	H5521_013_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	013	0	1	04	01	H5521_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	013	0	1	04	01	H5521_013_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											655.97	28						454.37	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	015	0	1	04	01	H5521_015_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	015	0	1	04	01	H5521_015_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	015	0	1	04	01	H5521_015_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	21.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	015	0	1	04	01	H5521_015_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	21.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	015	0	1	04	01	H5521_015_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	015	0	1	04	01	H5521_015_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	015	0	1	04	01	H5521_015_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											413.86	30						292.13	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	016	0	1	04	01	H5521_016_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	016	0	1	04	01	H5521_016_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	016	0	1	04	01	H5521_016_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	016	0	1	04	01	H5521_016_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	016	0	1	04	01	H5521_016_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	016	0	1	04	01	H5521_016_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	016	0	1	04	01	H5521_016_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											534.48	33						407.19	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	020	0	1	04	01	H5521_020_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	020	0	1	04	01	H5521_020_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	020	0	1	04	01	H5521_020_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	020	0	1	04	01	H5521_020_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	020	0	1	04	01	H5521_020_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	020	0	1	04	01	H5521_020_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	020	0	1	04	01	H5521_020_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											821.65	33						606.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	022	0	1	04	01	H5521_022_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	022	0	1	04	01	H5521_022_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	022	0	1	04	01	H5521_022_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	022	0	1	04	01	H5521_022_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	022	0	1	04	01	H5521_022_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	022	0	1	04	01	H5521_022_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	022	0	1	04	01	H5521_022_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											758.28	33						576.86	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	027	0	1	04	01	H5521_027_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	027	0	1	04	01	H5521_027_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	027	0	1	04	01	H5521_027_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	027	0	1	04	01	H5521_027_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	027	0	1	04	01	H5521_027_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	027	0	1	04	01	H5521_027_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	027	0	1	04	01	H5521_027_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											621.57	33						452.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	033	0	1	04	01	H5521_033_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	033	0	1	04	01	H5521_033_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	033	0	1	04	01	H5521_033_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	033	0	1	04	01	H5521_033_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	033	0	1	04	01	H5521_033_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	033	0	1	04	01	H5521_033_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	033	0	1	04	01	H5521_033_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											728.98	27						427.77	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	037	0	1	04	01	H5521_037_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	037	0	1	04	01	H5521_037_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	037	0	1	04	01	H5521_037_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	037	0	1	04	01	H5521_037_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	037	0	1	04	01	H5521_037_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	037	0	1	04	01	H5521_037_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	037	0	1	04	01	H5521_037_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											705.74	31						421.40	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	040	0	1	04	01	H5521_040_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	040	0	1	04	01	H5521_040_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	040	0	1	04	01	H5521_040_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	040	0	1	04	01	H5521_040_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	040	0	1	04	01	H5521_040_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	040	0	1	04	01	H5521_040_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	040	0	1	04	01	H5521_040_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											503.95	29						359.82	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	053	0	1	04	01	H5521_053_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	053	0	1	04	01	H5521_053_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	053	0	1	04	01	H5521_053_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	053	0	1	04	01	H5521_053_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	053	0	1	04	01	H5521_053_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	053	0	1	04	01	H5521_053_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	053	0	1	04	01	H5521_053_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											497.21	33						399.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	055	0	1	04	01	H5521_055_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	055	0	1	04	01	H5521_055_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	055	0	1	04	01	H5521_055_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	055	0	1	04	01	H5521_055_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	055	0	1	04	01	H5521_055_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	055	0	1	04	01	H5521_055_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	055	0	1	04	01	H5521_055_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											855.81	33						604.46	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	056	0	1	04	01	H5521_056_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	056	0	1	04	01	H5521_056_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	056	0	1	04	01	H5521_056_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	056	0	1	04	01	H5521_056_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	056	0	1	04	01	H5521_056_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	056	0	1	04	01	H5521_056_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	056	0	1	04	01	H5521_056_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											869.73	33						649.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	057	0	1	04	01	H5521_057_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	057	0	1	04	01	H5521_057_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	057	0	1	04	01	H5521_057_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	057	0	1	04	01	H5521_057_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	057	0	1	04	01	H5521_057_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	057	0	1	04	01	H5521_057_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	057	0	1	04	01	H5521_057_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											522.38	33						412.01	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	076	0	1	04	01	H5521_076_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	076	0	1	04	01	H5521_076_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	076	0	1	04	01	H5521_076_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	076	0	1	04	01	H5521_076_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	076	0	1	04	01	H5521_076_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	076	0	1	04	01	H5521_076_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	076	0	1	04	01	H5521_076_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											692.97	28						479.24	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	077	0	1	04	01	H5521_077_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	077	0	1	04	01	H5521_077_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	077	0	1	04	01	H5521_077_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	077	0	1	04	01	H5521_077_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	077	0	1	04	01	H5521_077_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	077	0	1	04	01	H5521_077_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	077	0	1	04	01	H5521_077_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											771.78	29						419.22	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	081	0	1	04	01	H5521_081_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	081	0	1	04	01	H5521_081_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	081	0	1	04	01	H5521_081_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	081	0	1	04	01	H5521_081_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	081	0	1	04	01	H5521_081_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	081	0	1	04	01	H5521_081_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	081	0	1	04	01	H5521_081_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											745.88	30						471.58	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	082	0	1	04	01	H5521_082_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	082	0	1	04	01	H5521_082_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	082	0	1	04	01	H5521_082_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	082	0	1	04	01	H5521_082_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	082	0	1	04	01	H5521_082_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	082	0	1	04	01	H5521_082_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	082	0	1	04	01	H5521_082_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											550.20	28						415.47	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	083	0	1	04	01	H5521_083_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	083	0	1	04	01	H5521_083_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	083	0	1	04	01	H5521_083_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	083	0	1	04	01	H5521_083_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	083	0	1	04	01	H5521_083_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	083	0	1	04	01	H5521_083_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	083	0	1	04	01	H5521_083_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											541.24	30						400.17	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	084	0	1	04	01	H5521_084_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	084	0	1	04	01	H5521_084_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	084	0	1	04	01	H5521_084_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	084	0	1	04	01	H5521_084_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	084	0	1	04	01	H5521_084_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	084	0	1	04	01	H5521_084_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	084	0	1	04	01	H5521_084_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											588.84	33						446.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	085	0	1	04	01	H5521_085_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	085	0	1	04	01	H5521_085_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	085	0	1	04	01	H5521_085_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	085	0	1	04	01	H5521_085_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	085	0	1	04	01	H5521_085_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	085	0	1	04	01	H5521_085_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	085	0	1	04	01	H5521_085_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											705.85	30						516.94	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	086	0	1	04	01	H5521_086_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	086	0	1	04	01	H5521_086_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	086	0	1	04	01	H5521_086_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	086	0	1	04	01	H5521_086_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	086	0	1	04	01	H5521_086_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	086	0	1	04	01	H5521_086_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	086	0	1	04	01	H5521_086_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											659.09	33						428.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	087	0	1	04	01	H5521_087_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	087	0	1	04	01	H5521_087_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	087	0	1	04	01	H5521_087_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	087	0	1	04	01	H5521_087_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	087	0	1	04	01	H5521_087_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	087	0	1	04	01	H5521_087_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	087	0	1	04	01	H5521_087_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1021.59	30						381.13	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	088	0	1	04	01	H5521_088_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	088	0	1	04	01	H5521_088_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	088	0	1	04	01	H5521_088_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	088	0	1	04	01	H5521_088_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	088	0	1	04	01	H5521_088_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	088	0	1	04	01	H5521_088_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	088	0	1	04	01	H5521_088_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											746.80	30						416.81	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	089	0	1	04	01	H5521_089_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	089	0	1	04	01	H5521_089_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	089	0	1	04	01	H5521_089_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	089	0	1	04	01	H5521_089_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	089	0	1	04	01	H5521_089_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	089	0	1	04	01	H5521_089_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	089	0	1	04	01	H5521_089_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											585.15	30						411.53	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	090	0	1	04	01	H5521_090_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	090	0	1	04	01	H5521_090_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	090	0	1	04	01	H5521_090_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	090	0	1	04	01	H5521_090_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	090	0	1	04	01	H5521_090_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	090	0	1	04	01	H5521_090_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	090	0	1	04	01	H5521_090_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											752.78	30						467.19	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	091	0	1	04	01	H5521_091_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	091	0	1	04	01	H5521_091_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	091	0	1	04	01	H5521_091_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	091	0	1	04	01	H5521_091_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	091	0	1	04	01	H5521_091_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	091	0	1	04	01	H5521_091_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	091	0	1	04	01	H5521_091_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											671.50	29						484.02	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	095	0	1	04	01	H5521_095_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	095	0	1	04	01	H5521_095_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	095	0	1	04	01	H5521_095_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	095	0	1	04	01	H5521_095_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	095	0	1	04	01	H5521_095_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	095	0	1	04	01	H5521_095_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	095	0	1	04	01	H5521_095_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											574.09	33						423.17	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	099	0	1	04	01	H5521_099_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	099	0	1	04	01	H5521_099_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	099	0	1	04	01	H5521_099_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	099	0	1	04	01	H5521_099_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	099	0	1	04	01	H5521_099_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	099	0	1	04	01	H5521_099_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	099	0	1	04	01	H5521_099_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											608.72	33						457.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	100	0	1	04	01	H5521_100_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	100	0	1	04	01	H5521_100_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	100	0	1	04	01	H5521_100_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	100	0	1	04	01	H5521_100_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	100	0	1	04	01	H5521_100_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	100	0	1	04	01	H5521_100_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	100	0	1	04	01	H5521_100_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											652.85	33						491.26	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	101	0	1	04	01	H5521_101_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	101	0	1	04	01	H5521_101_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	101	0	1	04	01	H5521_101_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	101	0	1	04	01	H5521_101_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	101	0	1	04	01	H5521_101_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	101	0	1	04	01	H5521_101_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	101	0	1	04	01	H5521_101_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											626.87	33						490.36	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	102	0	1	04	01	H5521_102_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	102	0	1	04	01	H5521_102_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	102	0	1	04	01	H5521_102_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	102	0	1	04	01	H5521_102_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	102	0	1	04	01	H5521_102_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	102	0	1	04	01	H5521_102_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	102	0	1	04	01	H5521_102_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											580.48	28						422.16	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	110	0	1	04	01	H5521_110_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	110	0	1	04	01	H5521_110_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	110	0	1	04	01	H5521_110_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	110	0	1	04	01	H5521_110_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	110	0	1	04	01	H5521_110_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	110	0	1	04	01	H5521_110_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	110	0	1	04	01	H5521_110_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											655.50	29						474.93	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	116	0	1	04	01	H5521_116_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	116	0	1	04	01	H5521_116_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	116	0	1	04	01	H5521_116_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	116	0	1	04	01	H5521_116_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	116	0	1	04	01	H5521_116_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	116	0	1	04	01	H5521_116_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	116	0	1	04	01	H5521_116_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											627.61	29						448.60	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	117	0	1	04	01	H5521_117_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	117	0	1	04	01	H5521_117_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	117	0	1	04	01	H5521_117_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	117	0	1	04	01	H5521_117_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	117	0	1	04	01	H5521_117_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	117	0	1	04	01	H5521_117_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	117	0	1	04	01	H5521_117_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											515.67	28						387.98	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	118	0	1	04	01	H5521_118_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	118	0	1	04	01	H5521_118_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	118	0	1	04	01	H5521_118_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	118	0	1	04	01	H5521_118_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	118	0	1	04	01	H5521_118_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	118	0	1	04	01	H5521_118_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	118	0	1	04	01	H5521_118_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											621.17	28						478.29	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	119	0	1	04	01	H5521_119_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	119	0	1	04	01	H5521_119_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	119	0	1	04	01	H5521_119_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	119	0	1	04	01	H5521_119_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	119	0	1	04	01	H5521_119_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	119	0	1	04	01	H5521_119_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	119	0	1	04	01	H5521_119_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											758.53	31						557.42	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	120	0	1	04	01	H5521_120_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	120	0	1	04	01	H5521_120_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	120	0	1	04	01	H5521_120_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	120	0	1	04	01	H5521_120_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	120	0	1	04	01	H5521_120_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	120	0	1	04	01	H5521_120_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	120	0	1	04	01	H5521_120_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											621.76	28						349.45	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	121	0	1	04	01	H5521_121_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	121	0	1	04	01	H5521_121_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	121	0	1	04	01	H5521_121_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	121	0	1	04	01	H5521_121_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	121	0	1	04	01	H5521_121_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	121	0	1	04	01	H5521_121_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	121	0	1	04	01	H5521_121_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											551.23	28						414.26	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	122	0	1	04	01	H5521_122_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	122	0	1	04	01	H5521_122_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	122	0	1	04	01	H5521_122_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	122	0	1	04	01	H5521_122_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	122	0	1	04	01	H5521_122_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	122	0	1	04	01	H5521_122_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	122	0	1	04	01	H5521_122_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											777.74	33						595.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	123	0	1	04	01	H5521_123_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	123	0	1	04	01	H5521_123_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	123	0	1	04	01	H5521_123_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	123	0	1	04	01	H5521_123_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	123	0	1	04	01	H5521_123_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	123	0	1	04	01	H5521_123_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	123	0	1	04	01	H5521_123_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											601.75	31						356.11	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	124	0	1	04	01	H5521_124_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	124	0	1	04	01	H5521_124_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	124	0	1	04	01	H5521_124_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	124	0	1	04	01	H5521_124_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	124	0	1	04	01	H5521_124_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	124	0	1	04	01	H5521_124_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	124	0	1	04	01	H5521_124_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											598.63	28						416.82	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	125	0	1	04	01	H5521_125_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	125	0	1	04	01	H5521_125_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	125	0	1	04	01	H5521_125_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	125	0	1	04	01	H5521_125_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	125	0	1	04	01	H5521_125_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	125	0	1	04	01	H5521_125_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	125	0	1	04	01	H5521_125_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											594.67	33						436.63	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	127	0	1	04	01	H5521_127_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	127	0	1	04	01	H5521_127_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	127	0	1	04	01	H5521_127_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	127	0	1	04	01	H5521_127_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	127	0	1	04	01	H5521_127_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	127	0	1	04	01	H5521_127_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	127	0	1	04	01	H5521_127_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											787.59	33						601.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	128	0	1	04	01	H5521_128_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	128	0	1	04	01	H5521_128_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	128	0	1	04	01	H5521_128_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	128	0	1	04	01	H5521_128_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	128	0	1	04	01	H5521_128_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	128	0	1	04	01	H5521_128_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	128	0	1	04	01	H5521_128_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											845.99	33						446.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	134	0	1	04	01	H5521_134_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	134	0	1	04	01	H5521_134_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	134	0	1	04	01	H5521_134_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	134	0	1	04	01	H5521_134_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	134	0	1	04	01	H5521_134_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	134	0	1	04	01	H5521_134_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	134	0	1	04	01	H5521_134_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											719.65	30						481.60	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	139	0	1	04	01	H5521_139_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	139	0	1	04	01	H5521_139_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	139	0	1	04	01	H5521_139_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	139	0	1	04	01	H5521_139_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	139	0	1	04	01	H5521_139_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	139	0	1	04	01	H5521_139_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	139	0	1	04	01	H5521_139_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											869.40	30						638.50	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	140	0	1	04	01	H5521_140_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	140	0	1	04	01	H5521_140_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	140	0	1	04	01	H5521_140_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	140	0	1	04	01	H5521_140_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	140	0	1	04	01	H5521_140_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	140	0	1	04	01	H5521_140_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	140	0	1	04	01	H5521_140_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											855.83	30						441.77	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	141	0	1	04	01	H5521_141_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	141	0	1	04	01	H5521_141_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	141	0	1	04	01	H5521_141_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	141	0	1	04	01	H5521_141_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	141	0	1	04	01	H5521_141_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	141	0	1	04	01	H5521_141_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	141	0	1	04	01	H5521_141_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											587.69	33						460.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	142	0	1	04	01	H5521_142_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	142	0	1	04	01	H5521_142_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	142	0	1	04	01	H5521_142_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	142	0	1	04	01	H5521_142_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	142	0	1	04	01	H5521_142_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	142	0	1	04	01	H5521_142_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	142	0	1	04	01	H5521_142_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											771.62	28						586.88	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	143	0	1	04	01	H5521_143_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	143	0	1	04	01	H5521_143_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	143	0	1	04	01	H5521_143_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	143	0	1	04	01	H5521_143_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	143	0	1	04	01	H5521_143_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	143	0	1	04	01	H5521_143_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	143	0	1	04	01	H5521_143_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											734.25	28						521.02	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	144	0	1	04	01	H5521_144_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	144	0	1	04	01	H5521_144_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	144	0	1	04	01	H5521_144_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	144	0	1	04	01	H5521_144_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	144	0	1	04	01	H5521_144_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	144	0	1	04	01	H5521_144_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	144	0	1	04	01	H5521_144_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											802.84	28						547.41	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	150	0	1	04	01	H5521_150_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	150	0	1	04	01	H5521_150_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	150	0	1	04	01	H5521_150_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	150	0	1	04	01	H5521_150_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	150	0	1	04	01	H5521_150_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	150	0	1	04	01	H5521_150_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	150	0	1	04	01	H5521_150_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											792.24	29						582.69	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	154	0	1	04	01	H5521_154_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	154	0	1	04	01	H5521_154_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	154	0	1	04	01	H5521_154_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	154	0	1	04	01	H5521_154_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	154	0	1	04	01	H5521_154_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	154	0	1	04	01	H5521_154_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	154	0	1	04	01	H5521_154_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											624.42	33						455.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	156	0	1	04	01	H5521_156_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	156	0	1	04	01	H5521_156_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	156	0	1	04	01	H5521_156_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	156	0	1	04	01	H5521_156_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	156	0	1	04	01	H5521_156_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	156	0	1	04	01	H5521_156_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	156	0	1	04	01	H5521_156_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											719.78	33						516.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	157	0	1	04	01	H5521_157_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	157	0	1	04	01	H5521_157_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	157	0	1	04	01	H5521_157_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	157	0	1	04	01	H5521_157_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	157	0	1	04	01	H5521_157_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	157	0	1	04	01	H5521_157_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	157	0	1	04	01	H5521_157_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											771.40	33						422.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	159	0	1	04	01	H5521_159_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	159	0	1	04	01	H5521_159_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00					15.00			15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	159	0	1	04	01	H5521_159_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	21.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	159	0	1	04	01	H5521_159_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	21.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	159	0	1	04	01	H5521_159_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	159	0	1	04	01	H5521_159_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	159	0	1	04	01	H5521_159_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											588.23	30						414.17	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	160	0	1	04	01	H5521_160_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	160	0	1	04	01	H5521_160_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	160	0	1	04	01	H5521_160_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	160	0	1	04	01	H5521_160_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	160	0	1	04	01	H5521_160_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	160	0	1	04	01	H5521_160_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	160	0	1	04	01	H5521_160_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											817.78	33						553.53	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	168	0	1	04	01	H5521_168_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	168	0	1	04	01	H5521_168_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	168	0	1	04	01	H5521_168_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	168	0	1	04	01	H5521_168_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	168	0	1	04	01	H5521_168_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	168	0	1	04	01	H5521_168_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	168	0	1	04	01	H5521_168_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											614.14	30						405.01	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	169	0	1	04	01	H5521_169_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	169	0	1	04	01	H5521_169_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	169	0	1	04	01	H5521_169_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	169	0	1	04	01	H5521_169_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	169	0	1	04	01	H5521_169_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	169	0	1	04	01	H5521_169_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	169	0	1	04	01	H5521_169_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											740.79	30						467.02	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	170	0	1	04	01	H5521_170_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	170	0	1	04	01	H5521_170_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	170	0	1	04	01	H5521_170_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	170	0	1	04	01	H5521_170_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	170	0	1	04	01	H5521_170_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	170	0	1	04	01	H5521_170_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	170	0	1	04	01	H5521_170_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											850.42	30						456.44	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	171	0	1	04	01	H5521_171_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	171	0	1	04	01	H5521_171_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	171	0	1	04	01	H5521_171_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	171	0	1	04	01	H5521_171_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	171	0	1	04	01	H5521_171_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	171	0	1	04	01	H5521_171_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	171	0	1	04	01	H5521_171_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											599.51	29						458.58	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	177	0	1	04	01	H5521_177_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	177	0	1	04	01	H5521_177_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	177	0	1	04	01	H5521_177_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	177	0	1	04	01	H5521_177_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	177	0	1	04	01	H5521_177_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	177	0	1	04	01	H5521_177_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	177	0	1	04	01	H5521_177_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											871.81	29						608.33	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	178	0	1	04	01	H5521_178_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	178	0	1	04	01	H5521_178_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	178	0	1	04	01	H5521_178_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	178	0	1	04	01	H5521_178_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	178	0	1	04	01	H5521_178_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	178	0	1	04	01	H5521_178_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	178	0	1	04	01	H5521_178_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											578.60	29						425.95	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	184	0	1	04	01	H5521_184_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	184	0	1	04	01	H5521_184_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	184	0	1	04	01	H5521_184_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	184	0	1	04	01	H5521_184_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	184	0	1	04	01	H5521_184_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	184	0	1	04	01	H5521_184_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	184	0	1	04	01	H5521_184_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											717.54	33						526.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	187	0	1	04	01	H5521_187_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	187	0	1	04	01	H5521_187_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	187	0	1	04	01	H5521_187_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	187	0	1	04	01	H5521_187_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	187	0	1	04	01	H5521_187_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	187	0	1	04	01	H5521_187_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	187	0	1	04	01	H5521_187_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											570.65	33						430.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	190	0	1	04	01	H5521_190_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	190	0	1	04	01	H5521_190_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	190	0	1	04	01	H5521_190_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	190	0	1	04	01	H5521_190_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	190	0	1	04	01	H5521_190_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	190	0	1	04	01	H5521_190_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	190	0	1	04	01	H5521_190_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											817.20	33						608.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	194	0	1	04	01	H5521_194_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	194	0	1	04	01	H5521_194_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	194	0	1	04	01	H5521_194_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	194	0	1	04	01	H5521_194_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	194	0	1	04	01	H5521_194_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	194	0	1	04	01	H5521_194_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	194	0	1	04	01	H5521_194_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											655.54	33						488.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	195	0	1	04	01	H5521_195_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	195	0	1	04	01	H5521_195_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	195	0	1	04	01	H5521_195_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	195	0	1	04	01	H5521_195_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	195	0	1	04	01	H5521_195_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	195	0	1	04	01	H5521_195_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	195	0	1	04	01	H5521_195_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											691.66	29						454.48	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	196	0	1	04	01	H5521_196_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	196	0	1	04	01	H5521_196_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	196	0	1	04	01	H5521_196_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	196	0	1	04	01	H5521_196_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	196	0	1	04	01	H5521_196_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	196	0	1	04	01	H5521_196_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	196	0	1	04	01	H5521_196_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											655.38	27						454.86	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	197	0	1	04	01	H5521_197_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	197	0	1	04	01	H5521_197_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	197	0	1	04	01	H5521_197_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	197	0	1	04	01	H5521_197_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	197	0	1	04	01	H5521_197_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	197	0	1	04	01	H5521_197_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	197	0	1	04	01	H5521_197_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											588.18	31						438.12	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	200	0	1	04	01	H5521_200_0	3		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	200	0	1	04	01	H5521_200_0	3		N	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	200	0	1	04	01	H5521_200_0	3		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	200	0	1	04	01	H5521_200_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	200	0	1	04	01	H5521_200_0	3		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											639.80	27						486.66	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	205	0	1	04	01	H5521_205_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	205	0	1	04	01	H5521_205_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	205	0	1	04	01	H5521_205_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	205	0	1	04	01	H5521_205_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	205	0	1	04	01	H5521_205_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	205	0	1	04	01	H5521_205_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	205	0	1	04	01	H5521_205_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											692.60	33						501.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	206	0	1	04	01	H5521_206_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	206	0	1	04	01	H5521_206_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	206	0	1	04	01	H5521_206_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	206	0	1	04	01	H5521_206_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	206	0	1	04	01	H5521_206_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	206	0	1	04	01	H5521_206_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	206	0	1	04	01	H5521_206_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											700.75	33						520.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	207	0	1	04	01	H5521_207_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	207	0	1	04	01	H5521_207_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	207	0	1	04	01	H5521_207_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	207	0	1	04	01	H5521_207_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	207	0	1	04	01	H5521_207_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	207	0	1	04	01	H5521_207_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	207	0	1	04	01	H5521_207_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											773.35	33						550.77	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	211	0	1	04	01	H5521_211_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	211	0	1	04	01	H5521_211_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	211	0	1	04	01	H5521_211_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	211	0	1	04	01	H5521_211_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	211	0	1	04	01	H5521_211_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	211	0	1	04	01	H5521_211_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	211	0	1	04	01	H5521_211_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											723.00	33						520.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	212	0	1	04	01	H5521_212_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	212	0	1	04	01	H5521_212_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	212	0	1	04	01	H5521_212_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	212	0	1	04	01	H5521_212_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	212	0	1	04	01	H5521_212_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	212	0	1	04	01	H5521_212_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	212	0	1	04	01	H5521_212_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											779.85	33						563.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	214	0	1	04	01	H5521_214_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	214	0	1	04	01	H5521_214_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	214	0	1	04	01	H5521_214_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	214	0	1	04	01	H5521_214_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	214	0	1	04	01	H5521_214_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	214	0	1	04	01	H5521_214_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	214	0	1	04	01	H5521_214_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											593.14	33						404.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	215	0	1	04	01	H5521_215_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	215	0	1	04	01	H5521_215_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	215	0	1	04	01	H5521_215_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	215	0	1	04	01	H5521_215_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	215	0	1	04	01	H5521_215_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	215	0	1	04	01	H5521_215_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	215	0	1	04	01	H5521_215_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											667.54	31						514.86	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	216	0	1	04	01	H5521_216_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	216	0	1	04	01	H5521_216_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	216	0	1	04	01	H5521_216_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	216	0	1	04	01	H5521_216_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	216	0	1	04	01	H5521_216_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	216	0	1	04	01	H5521_216_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	216	0	1	04	01	H5521_216_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											670.05	33						503.58	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	217	0	1	04	01	H5521_217_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	217	0	1	04	01	H5521_217_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	217	0	1	04	01	H5521_217_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	217	0	1	04	01	H5521_217_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	217	0	1	04	01	H5521_217_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	217	0	1	04	01	H5521_217_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	217	0	1	04	01	H5521_217_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											688.07	33						540.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	218	0	1	04	01	H5521_218_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	218	0	1	04	01	H5521_218_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	218	0	1	04	01	H5521_218_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	218	0	1	04	01	H5521_218_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	218	0	1	04	01	H5521_218_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	218	0	1	04	01	H5521_218_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	218	0	1	04	01	H5521_218_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											514.35	29						401.65	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	219	0	1	04	01	H5521_219_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	219	0	1	04	01	H5521_219_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	219	0	1	04	01	H5521_219_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	219	0	1	04	01	H5521_219_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	219	0	1	04	01	H5521_219_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	219	0	1	04	01	H5521_219_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	219	0	1	04	01	H5521_219_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											814.62	33						613.03	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	220	0	1	04	01	H5521_220_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	220	0	1	04	01	H5521_220_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	220	0	1	04	01	H5521_220_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	220	0	1	04	01	H5521_220_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	220	0	1	04	01	H5521_220_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	220	0	1	04	01	H5521_220_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	220	0	1	04	01	H5521_220_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											599.52	29						445.31	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	221	0	1	04	01	H5521_221_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	221	0	1	04	01	H5521_221_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	221	0	1	04	01	H5521_221_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	221	0	1	04	01	H5521_221_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	221	0	1	04	01	H5521_221_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	221	0	1	04	01	H5521_221_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	221	0	1	04	01	H5521_221_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											780.56	33						573.21	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	222	0	1	04	01	H5521_222_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	222	0	1	04	01	H5521_222_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	222	0	1	04	01	H5521_222_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	222	0	1	04	01	H5521_222_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	222	0	1	04	01	H5521_222_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	222	0	1	04	01	H5521_222_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	222	0	1	04	01	H5521_222_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											567.10	29						430.90	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	223	0	1	04	01	H5521_223_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	223	0	1	04	01	H5521_223_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	223	0	1	04	01	H5521_223_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	223	0	1	04	01	H5521_223_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	223	0	1	04	01	H5521_223_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	223	0	1	04	01	H5521_223_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	223	0	1	04	01	H5521_223_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											693.04	33						503.21	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	224	0	1	04	01	H5521_224_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	224	0	1	04	01	H5521_224_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	224	0	1	04	01	H5521_224_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	224	0	1	04	01	H5521_224_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	224	0	1	04	01	H5521_224_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	224	0	1	04	01	H5521_224_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	224	0	1	04	01	H5521_224_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											622.44	29						462.99	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	226	0	1	04	01	H5521_226_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	226	0	1	04	01	H5521_226_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	226	0	1	04	01	H5521_226_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	226	0	1	04	01	H5521_226_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	226	0	1	04	01	H5521_226_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	226	0	1	04	01	H5521_226_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	226	0	1	04	01	H5521_226_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											664.66	33						502.01	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	227	0	1	04	01	H5521_227_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	227	0	1	04	01	H5521_227_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	227	0	1	04	01	H5521_227_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	227	0	1	04	01	H5521_227_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	227	0	1	04	01	H5521_227_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	227	0	1	04	01	H5521_227_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	227	0	1	04	01	H5521_227_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											586.36	29						430.32	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	228	0	1	04	01	H5521_228_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	228	0	1	04	01	H5521_228_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	228	0	1	04	01	H5521_228_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	228	0	1	04	01	H5521_228_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	228	0	1	04	01	H5521_228_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	228	0	1	04	01	H5521_228_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	228	0	1	04	01	H5521_228_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											611.03	33						437.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	230	0	1	04	01	H5521_230_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	230	0	1	04	01	H5521_230_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	230	0	1	04	01	H5521_230_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	230	0	1	04	01	H5521_230_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	230	0	1	04	01	H5521_230_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	230	0	1	04	01	H5521_230_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	230	0	1	04	01	H5521_230_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											611.79	29						440.80	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	231	0	1	04	01	H5521_231_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	231	0	1	04	01	H5521_231_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	231	0	1	04	01	H5521_231_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	231	0	1	04	01	H5521_231_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	231	0	1	04	01	H5521_231_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	231	0	1	04	01	H5521_231_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	231	0	1	04	01	H5521_231_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											696.61	33						503.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	232	0	1	04	01	H5521_232_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	232	0	1	04	01	H5521_232_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	232	0	1	04	01	H5521_232_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	232	0	1	04	01	H5521_232_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	232	0	1	04	01	H5521_232_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	232	0	1	04	01	H5521_232_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	232	0	1	04	01	H5521_232_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											605.67	29						441.58	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	233	0	1	04	01	H5521_233_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	233	0	1	04	01	H5521_233_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	233	0	1	04	01	H5521_233_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	233	0	1	04	01	H5521_233_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	233	0	1	04	01	H5521_233_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	233	0	1	04	01	H5521_233_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	233	0	1	04	01	H5521_233_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											605.68	29						437.81	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	234	0	1	04	01	H5521_234_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	234	0	1	04	01	H5521_234_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	234	0	1	04	01	H5521_234_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	234	0	1	04	01	H5521_234_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	234	0	1	04	01	H5521_234_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	234	0	1	04	01	H5521_234_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	234	0	1	04	01	H5521_234_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											719.21	29						515.11	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	236	0	1	04	01	H5521_236_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	236	0	1	04	01	H5521_236_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	236	0	1	04	01	H5521_236_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	236	0	1	04	01	H5521_236_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	236	0	1	04	01	H5521_236_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	236	0	1	04	01	H5521_236_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	236	0	1	04	01	H5521_236_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											771.70	30						520.16	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	237	0	1	04	01	H5521_237_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	237	0	1	04	01	H5521_237_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	237	0	1	04	01	H5521_237_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	237	0	1	04	01	H5521_237_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	237	0	1	04	01	H5521_237_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	237	0	1	04	01	H5521_237_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	237	0	1	04	01	H5521_237_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											804.88	33						579.73	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	239	0	1	04	01	H5521_239_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	239	0	1	04	01	H5521_239_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	239	0	1	04	01	H5521_239_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	239	0	1	04	01	H5521_239_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	239	0	1	04	01	H5521_239_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	239	0	1	04	01	H5521_239_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	239	0	1	04	01	H5521_239_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											809.47	30						590.52	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	243	0	1	04	01	H5521_243_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	243	0	1	04	01	H5521_243_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	243	0	1	04	01	H5521_243_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	243	0	1	04	01	H5521_243_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	243	0	1	04	01	H5521_243_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	243	0	1	04	01	H5521_243_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	243	0	1	04	01	H5521_243_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											584.33	30						444.37	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	244	0	1	04	01	H5521_244_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	244	0	1	04	01	H5521_244_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	244	0	1	04	01	H5521_244_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	244	0	1	04	01	H5521_244_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	244	0	1	04	01	H5521_244_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	244	0	1	04	01	H5521_244_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	244	0	1	04	01	H5521_244_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											768.39	33						565.07	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	245	0	1	04	01	H5521_245_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	245	0	1	04	01	H5521_245_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	245	0	1	04	01	H5521_245_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	245	0	1	04	01	H5521_245_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	245	0	1	04	01	H5521_245_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	245	0	1	04	01	H5521_245_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	245	0	1	04	01	H5521_245_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											774.69	33						520.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	246	0	1	04	01	H5521_246_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	246	0	1	04	01	H5521_246_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	246	0	1	04	01	H5521_246_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	246	0	1	04	01	H5521_246_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	246	0	1	04	01	H5521_246_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	246	0	1	04	01	H5521_246_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	246	0	1	04	01	H5521_246_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											685.33	33						509.70	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	247	0	1	04	01	H5521_247_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	247	0	1	04	01	H5521_247_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	247	0	1	04	01	H5521_247_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	247	0	1	04	01	H5521_247_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	0.00											10.00	20.00	30.00				5.00	10.00	0.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	247	0	1	04	01	H5521_247_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	247	0	1	04	01	H5521_247_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	247	0	1	04	01	H5521_247_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											724.52	33						538.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	249	0	1	04	01	H5521_249_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	249	0	1	04	01	H5521_249_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	249	0	1	04	01	H5521_249_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	249	0	1	04	01	H5521_249_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	249	0	1	04	01	H5521_249_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	249	0	1	04	01	H5521_249_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	249	0	1	04	01	H5521_249_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											647.47	30						465.55	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	250	0	1	04	01	H5521_250_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	250	0	1	04	01	H5521_250_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	250	0	1	04	01	H5521_250_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	250	0	1	04	01	H5521_250_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	250	0	1	04	01	H5521_250_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	250	0	1	04	01	H5521_250_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	250	0	1	04	01	H5521_250_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											851.93	33						601.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	251	0	1	04	01	H5521_251_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	251	0	1	04	01	H5521_251_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	251	0	1	04	01	H5521_251_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	251	0	1	04	01	H5521_251_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	251	0	1	04	01	H5521_251_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	251	0	1	04	01	H5521_251_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	251	0	1	04	01	H5521_251_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											687.85	30						535.63	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	252	0	1	04	01	H5521_252_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	252	0	1	04	01	H5521_252_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	252	0	1	04	01	H5521_252_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	252	0	1	04	01	H5521_252_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	252	0	1	04	01	H5521_252_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	252	0	1	04	01	H5521_252_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	252	0	1	04	01	H5521_252_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											809.07	31						573.09	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	253	0	1	04	01	H5521_253_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	253	0	1	04	01	H5521_253_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	253	0	1	04	01	H5521_253_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	253	0	1	04	01	H5521_253_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	253	0	1	04	01	H5521_253_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	253	0	1	04	01	H5521_253_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	253	0	1	04	01	H5521_253_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											757.96	33						561.95	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	254	0	1	04	01	H5521_254_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	254	0	1	04	01	H5521_254_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	254	0	1	04	01	H5521_254_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	254	0	1	04	01	H5521_254_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	254	0	1	04	01	H5521_254_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	254	0	1	04	01	H5521_254_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	254	0	1	04	01	H5521_254_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											739.01	33						537.28	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	259	0	1	04	01	H5521_259_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	259	0	1	04	01	H5521_259_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	259	0	1	04	01	H5521_259_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	259	0	1	04	01	H5521_259_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	259	0	1	04	01	H5521_259_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	259	0	1	04	01	H5521_259_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	259	0	1	04	01	H5521_259_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											688.95	30						501.13	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	260	0	1	04	01	H5521_260_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	260	0	1	04	01	H5521_260_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	260	0	1	04	01	H5521_260_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	260	0	1	04	01	H5521_260_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	260	0	1	04	01	H5521_260_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	260	0	1	04	01	H5521_260_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	260	0	1	04	01	H5521_260_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											656.13	30						479.11	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	261	0	1	04	01	H5521_261_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5521	261	0	1	04	01	H5521_261_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5521	261	0	1	04	01	H5521_261_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5521	261	0	1	04	01	H5521_261_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5521	261	0	1	04	01	H5521_261_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	261	0	1	04	01	H5521_261_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	261	0	1	04	01	H5521_261_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											728.67	33						564.24	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	262	0	1	04	01	H5521_262_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	262	0	1	04	01	H5521_262_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	262	0	1	04	01	H5521_262_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	262	0	1	04	01	H5521_262_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	262	0	1	04	01	H5521_262_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	262	0	1	04	01	H5521_262_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	262	0	1	04	01	H5521_262_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											577.97	29						429.95	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	263	0	1	04	01	H5521_263_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	263	0	1	04	01	H5521_263_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	263	0	1	04	01	H5521_263_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	263	0	1	04	01	H5521_263_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	263	0	1	04	01	H5521_263_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	263	0	1	04	01	H5521_263_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	263	0	1	04	01	H5521_263_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											791.61	33						454.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	266	0	1	04	01	H5521_266_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	266	0	1	04	01	H5521_266_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	266	0	1	04	01	H5521_266_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	266	0	1	04	01	H5521_266_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	266	0	1	04	01	H5521_266_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	266	0	1	04	01	H5521_266_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	266	0	1	04	01	H5521_266_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											706.81	33						520.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	267	0	1	04	01	H5521_267_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	267	0	1	04	01	H5521_267_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	267	0	1	04	01	H5521_267_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	267	0	1	04	01	H5521_267_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	267	0	1	04	01	H5521_267_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	267	0	1	04	01	H5521_267_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	267	0	1	04	01	H5521_267_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											819.08	30						597.09	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	268	0	1	04	01	H5521_268_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	268	0	1	04	01	H5521_268_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	268	0	1	04	01	H5521_268_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	268	0	1	04	01	H5521_268_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	268	0	1	04	01	H5521_268_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	268	0	1	04	01	H5521_268_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	268	0	1	04	01	H5521_268_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											702.58	30						510.12	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	269	0	1	04	01	H5521_269_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	269	0	1	04	01	H5521_269_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	269	0	1	04	01	H5521_269_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	269	0	1	04	01	H5521_269_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	269	0	1	04	01	H5521_269_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	269	0	1	04	01	H5521_269_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	269	0	1	04	01	H5521_269_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											676.23	30						492.60	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	270	0	1	04	01	H5521_270_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	270	0	1	04	01	H5521_270_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	270	0	1	04	01	H5521_270_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	270	0	1	04	01	H5521_270_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	270	0	1	04	01	H5521_270_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	270	0	1	04	01	H5521_270_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	270	0	1	04	01	H5521_270_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											719.42	30						522.17	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	271	0	1	04	01	H5521_271_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	271	0	1	04	01	H5521_271_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	271	0	1	04	01	H5521_271_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	271	0	1	04	01	H5521_271_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	271	0	1	04	01	H5521_271_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	271	0	1	04	01	H5521_271_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	271	0	1	04	01	H5521_271_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											713.44	30						517.52	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	272	0	1	04	01	H5521_272_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	272	0	1	04	01	H5521_272_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	272	0	1	04	01	H5521_272_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	272	0	1	04	01	H5521_272_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	272	0	1	04	01	H5521_272_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	272	0	1	04	01	H5521_272_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	272	0	1	04	01	H5521_272_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											712.01	30						516.97	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	273	0	1	04	01	H5521_273_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	273	0	1	04	01	H5521_273_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	273	0	1	04	01	H5521_273_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	273	0	1	04	01	H5521_273_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	273	0	1	04	01	H5521_273_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	273	0	1	04	01	H5521_273_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	273	0	1	04	01	H5521_273_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											712.59	30						517.31	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	275	0	1	04	01	H5521_275_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	275	0	1	04	01	H5521_275_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	275	0	1	04	01	H5521_275_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	275	0	1	04	01	H5521_275_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	275	0	1	04	01	H5521_275_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	275	0	1	04	01	H5521_275_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	275	0	1	04	01	H5521_275_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											628.36	28						465.86	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	277	0	1	04	01	H5521_277_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	277	0	1	04	01	H5521_277_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	277	0	1	04	01	H5521_277_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	277	0	1	04	01	H5521_277_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	277	0	1	04	01	H5521_277_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	277	0	1	04	01	H5521_277_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	277	0	1	04	01	H5521_277_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											602.57	27						445.10	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	278	0	1	04	01	H5521_278_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	278	0	1	04	01	H5521_278_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	278	0	1	04	01	H5521_278_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	278	0	1	04	01	H5521_278_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	278	0	1	04	01	H5521_278_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	278	0	1	04	01	H5521_278_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	278	0	1	04	01	H5521_278_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											640.80	29						477.96	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	280	0	1	04	01	H5521_280_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	280	0	1	04	01	H5521_280_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	280	0	1	04	01	H5521_280_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	280	0	1	04	01	H5521_280_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	280	0	1	04	01	H5521_280_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	280	0	1	04	01	H5521_280_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	280	0	1	04	01	H5521_280_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											734.55	33						536.13	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	281	0	1	04	01	H5521_281_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	281	0	1	04	01	H5521_281_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	281	0	1	04	01	H5521_281_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	281	0	1	04	01	H5521_281_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	281	0	1	04	01	H5521_281_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	281	0	1	04	01	H5521_281_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	281	0	1	04	01	H5521_281_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											741.79	33						538.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	282	0	1	04	01	H5521_282_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5521	282	0	1	04	01	H5521_282_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5521	282	0	1	04	01	H5521_282_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5521	282	0	1	04	01	H5521_282_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5521	282	0	1	04	01	H5521_282_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	282	0	1	04	01	H5521_282_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	282	0	1	04	01	H5521_282_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											712.91	33						556.13	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	283	0	1	04	01	H5521_283_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5521	283	0	1	04	01	H5521_283_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5521	283	0	1	04	01	H5521_283_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5521	283	0	1	04	01	H5521_283_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5521	283	0	1	04	01	H5521_283_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	283	0	1	04	01	H5521_283_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	283	0	1	04	01	H5521_283_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											720.99	33						561.88	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	284	0	1	04	01	H5521_284_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	284	0	1	04	01	H5521_284_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	284	0	1	04	01	H5521_284_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	284	0	1	04	01	H5521_284_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	284	0	1	04	01	H5521_284_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	284	0	1	04	01	H5521_284_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	284	0	1	04	01	H5521_284_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											752.09	33						548.14	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	285	0	1	04	01	H5521_285_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	285	0	1	04	01	H5521_285_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	285	0	1	04	01	H5521_285_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	285	0	1	04	01	H5521_285_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	285	0	1	04	01	H5521_285_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	285	0	1	04	01	H5521_285_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	285	0	1	04	01	H5521_285_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											757.93	33						550.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	288	0	1	04	01	H5521_288_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	288	0	1	04	01	H5521_288_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00					3.00			3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	288	0	1	04	01	H5521_288_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	288	0	1	04	01	H5521_288_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					5.00	10.00	0.00											7.00	14.00	21.00				5.00	10.00	0.00					7.00			7.00			0.23	0.17		0.23	0.17	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	288	0	1	04	01	H5521_288_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	288	0	1	04	01	H5521_288_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	288	0	1	04	01	H5521_288_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											690.71	33						508.19	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	289	0	1	04	01	H5521_289_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	289	0	1	04	01	H5521_289_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	289	0	1	04	01	H5521_289_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	289	0	1	04	01	H5521_289_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	289	0	1	04	01	H5521_289_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	289	0	1	04	01	H5521_289_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	289	0	1	04	01	H5521_289_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											658.35	29						482.93	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	290	0	1	04	01	H5521_290_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	290	0	1	04	01	H5521_290_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	290	0	1	04	01	H5521_290_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	290	0	1	04	01	H5521_290_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	290	0	1	04	01	H5521_290_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	290	0	1	04	01	H5521_290_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	290	0	1	04	01	H5521_290_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											773.39	33						566.91	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	292	0	1	04	01	H5521_292_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	292	0	1	04	01	H5521_292_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	292	0	1	04	01	H5521_292_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	292	0	1	04	01	H5521_292_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	292	0	1	04	01	H5521_292_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	292	0	1	04	01	H5521_292_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	292	0	1	04	01	H5521_292_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											678.39	33						509.85	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	293	0	1	04	01	H5521_293_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	293	0	1	04	01	H5521_293_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	293	0	1	04	01	H5521_293_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	293	0	1	04	01	H5521_293_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	293	0	1	04	01	H5521_293_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	293	0	1	04	01	H5521_293_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	293	0	1	04	01	H5521_293_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											723.22	33						527.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	294	0	1	04	01	H5521_294_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	294	0	1	04	01	H5521_294_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	294	0	1	04	01	H5521_294_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	294	0	1	04	01	H5521_294_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	294	0	1	04	01	H5521_294_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	294	0	1	04	01	H5521_294_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	294	0	1	04	01	H5521_294_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											757.99	33						554.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	295	0	1	04	01	H5521_295_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	295	0	1	04	01	H5521_295_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	295	0	1	04	01	H5521_295_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	295	0	1	04	01	H5521_295_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	295	0	1	04	01	H5521_295_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	295	0	1	04	01	H5521_295_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	295	0	1	04	01	H5521_295_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											598.58	28						448.45	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	298	0	1	04	01	H5521_298_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	298	0	1	04	01	H5521_298_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	298	0	1	04	01	H5521_298_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	298	0	1	04	01	H5521_298_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	298	0	1	04	01	H5521_298_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	298	0	1	04	01	H5521_298_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	298	0	1	04	01	H5521_298_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											606.34	27						446.55	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	299	0	1	04	01	H5521_299_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	299	0	1	04	01	H5521_299_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	299	0	1	04	01	H5521_299_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	299	0	1	04	01	H5521_299_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	299	0	1	04	01	H5521_299_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	299	0	1	04	01	H5521_299_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	299	0	1	04	01	H5521_299_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											751.53	33						548.40	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	300	0	1	04	01	H5521_300_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	300	0	1	04	01	H5521_300_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	300	0	1	04	01	H5521_300_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	300	0	1	04	01	H5521_300_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	300	0	1	04	01	H5521_300_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	300	0	1	04	01	H5521_300_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	300	0	1	04	01	H5521_300_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											771.28	33						562.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	301	0	1	04	01	H5521_301_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	301	0	1	04	01	H5521_301_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	301	0	1	04	01	H5521_301_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	301	0	1	04	01	H5521_301_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	301	0	1	04	01	H5521_301_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	301	0	1	04	01	H5521_301_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	301	0	1	04	01	H5521_301_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											751.85	33						548.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	302	0	1	04	01	H5521_302_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	302	0	1	04	01	H5521_302_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	302	0	1	04	01	H5521_302_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	302	0	1	04	01	H5521_302_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	302	0	1	04	01	H5521_302_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	302	0	1	04	01	H5521_302_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	302	0	1	04	01	H5521_302_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											707.09	33						520.32	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	303	0	1	04	01	H5521_303_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	303	0	1	04	01	H5521_303_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	303	0	1	04	01	H5521_303_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	303	0	1	04	01	H5521_303_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	303	0	1	04	01	H5521_303_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	303	0	1	04	01	H5521_303_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	303	0	1	04	01	H5521_303_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											729.94	33						533.46	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	304	0	1	04	01	H5521_304_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	304	0	1	04	01	H5521_304_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	304	0	1	04	01	H5521_304_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	304	0	1	04	01	H5521_304_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	304	0	1	04	01	H5521_304_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	304	0	1	04	01	H5521_304_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	304	0	1	04	01	H5521_304_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											715.49	33						525.94	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	305	0	1	04	01	H5521_305_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	305	0	1	04	01	H5521_305_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	305	0	1	04	01	H5521_305_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	305	0	1	04	01	H5521_305_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	305	0	1	04	01	H5521_305_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	305	0	1	04	01	H5521_305_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	305	0	1	04	01	H5521_305_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											673.10	30						490.33	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	307	0	1	04	01	H5521_307_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	307	0	1	04	01	H5521_307_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	307	0	1	04	01	H5521_307_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	307	0	1	04	01	H5521_307_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	307	0	1	04	01	H5521_307_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	307	0	1	04	01	H5521_307_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	307	0	1	04	01	H5521_307_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											766.16	33						559.99	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	309	0	1	04	01	H5521_309_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	309	0	1	04	01	H5521_309_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	309	0	1	04	01	H5521_309_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	309	0	1	04	01	H5521_309_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	309	0	1	04	01	H5521_309_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	309	0	1	04	01	H5521_309_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	309	0	1	04	01	H5521_309_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											620.62	27						450.82	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	310	0	1	04	01	H5521_310_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	310	0	1	04	01	H5521_310_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	310	0	1	04	01	H5521_310_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	310	0	1	04	01	H5521_310_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	310	0	1	04	01	H5521_310_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	310	0	1	04	01	H5521_310_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	310	0	1	04	01	H5521_310_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											659.50	27						473.65	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	311	0	1	04	01	H5521_311_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	311	0	1	04	01	H5521_311_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	311	0	1	04	01	H5521_311_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	311	0	1	04	01	H5521_311_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	311	0	1	04	01	H5521_311_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	311	0	1	04	01	H5521_311_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	311	0	1	04	01	H5521_311_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											757.06	33						553.96	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	312	0	1	04	01	H5521_312_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	312	0	1	04	01	H5521_312_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	312	0	1	04	01	H5521_312_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	312	0	1	04	01	H5521_312_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	312	0	1	04	01	H5521_312_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	312	0	1	04	01	H5521_312_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	312	0	1	04	01	H5521_312_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											630.57	28						459.06	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	313	0	1	04	01	H5521_313_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	313	0	1	04	01	H5521_313_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	313	0	1	04	01	H5521_313_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	313	0	1	04	01	H5521_313_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	313	0	1	04	01	H5521_313_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	313	0	1	04	01	H5521_313_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	313	0	1	04	01	H5521_313_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											687.30	28						495.79	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	314	0	1	04	01	H5521_314_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	314	0	1	04	01	H5521_314_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	314	0	1	04	01	H5521_314_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	314	0	1	04	01	H5521_314_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	314	0	1	04	01	H5521_314_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	314	0	1	04	01	H5521_314_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	314	0	1	04	01	H5521_314_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											670.30	33						495.52	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	318	0	1	04	01	H5521_318_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	318	0	1	04	01	H5521_318_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	318	0	1	04	01	H5521_318_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	318	0	1	04	01	H5521_318_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	318	0	1	04	01	H5521_318_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	318	0	1	04	01	H5521_318_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	318	0	1	04	01	H5521_318_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											708.05	27						505.50	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	319	0	1	04	01	H5521_319_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	319	0	1	04	01	H5521_319_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	319	0	1	04	01	H5521_319_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	319	0	1	04	01	H5521_319_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	319	0	1	04	01	H5521_319_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	319	0	1	04	01	H5521_319_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	319	0	1	04	01	H5521_319_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											779.48	33						570.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	321	0	1	04	01	H5521_321_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	321	0	1	04	01	H5521_321_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	321	0	1	04	01	H5521_321_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	321	0	1	04	01	H5521_321_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	321	0	1	04	01	H5521_321_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	321	0	1	04	01	H5521_321_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	321	0	1	04	01	H5521_321_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											787.20	33						574.77	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	326	0	1	04	01	H5521_326_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	326	0	1	04	01	H5521_326_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	326	0	1	04	01	H5521_326_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	326	0	1	04	01	H5521_326_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	326	0	1	04	01	H5521_326_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	326	0	1	04	01	H5521_326_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	326	0	1	04	01	H5521_326_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											622.55	29						453.91	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	328	0	1	04	01	H5521_328_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	328	0	1	04	01	H5521_328_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	328	0	1	04	01	H5521_328_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	328	0	1	04	01	H5521_328_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	328	0	1	04	01	H5521_328_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	328	0	1	04	01	H5521_328_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5521	328	0	1	04	01	H5521_328_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											641.51	29						466.55	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	001	0	1	04	01	H5522_001_0	5		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	001	0	1	04	01	H5522_001_0	5		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	001	0	1	04	01	H5522_001_0	5		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	001	0	1	04	01	H5522_001_0	5		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	001	0	1	04	01	H5522_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	001	0	1	04	01	H5522_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	001	0	1	04	01	H5522_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											775.21	33						400.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	002	0	1	04	01	H5522_002_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	002	0	1	04	01	H5522_002_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	002	0	1	04	01	H5522_002_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	002	0	1	04	01	H5522_002_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	002	0	1	04	01	H5522_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00					47.00			47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	002	0	1	04	01	H5522_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					99.00	198.00	297.00											100.00	200.00	300.00				99.00	198.00	297.00					100.00			100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	002	0	1	04	01	H5522_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											773.54	33						495.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	004	0	1	04	01	H5522_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	004	0	1	04	01	H5522_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	004	0	1	04	01	H5522_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	004	0	1	04	01	H5522_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	004	0	1	04	01	H5522_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	004	0	1	04	01	H5522_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	004	0	1	04	01	H5522_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											818.26	33						466.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	005	0	1	04	01	H5522_005_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	005	0	1	04	01	H5522_005_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	005	0	1	04	01	H5522_005_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	005	0	1	04	01	H5522_005_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	005	0	1	04	01	H5522_005_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	005	0	1	04	01	H5522_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	005	0	1	04	01	H5522_005_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											930.53	33						522.74	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	013	0	1	04	01	H5522_013_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	013	0	1	04	01	H5522_013_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	013	0	1	04	01	H5522_013_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	013	0	1	04	01	H5522_013_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	013	0	1	04	01	H5522_013_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	013	0	1	04	01	H5522_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	013	0	1	04	01	H5522_013_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											674.24	33						465.55	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	014	0	1	04	01	H5522_014_0	3		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	014	0	1	04	01	H5522_014_0	3		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	014	0	1	04	01	H5522_014_0	3		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	014	0	1	04	01	H5522_014_0	3		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	014	0	1	04	01	H5522_014_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	014	0	1	04	01	H5522_014_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	014	0	1	04	01	H5522_014_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											621.10	33						512.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	017	0	1	04	01	H5522_017_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					3.00	6.00	0.00											15.00	30.00	45.00				3.00	6.00	0.00					15.00			15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	017	0	1	04	01	H5522_017_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					3.00	6.00	0.00											15.00	30.00	45.00				3.00	6.00	0.00					15.00			15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	017	0	1	04	01	H5522_017_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	14.00											20.00	40.00	60.00				7.00	14.00	14.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	017	0	1	04	01	H5522_017_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	14.00											20.00	40.00	60.00				7.00	14.00	14.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	017	0	1	04	01	H5522_017_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	017	0	1	04	01	H5522_017_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	017	0	1	04	01	H5522_017_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											715.35	28						472.17	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	018	0	1	04	01	H5522_018_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	018	0	1	04	01	H5522_018_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	018	0	1	04	01	H5522_018_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
H5522	018	0	1	04	01	H5522_018_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5522	018	0	1	04	01	H5522_018_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	018	0	1	04	01	H5522_018_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5522	018	0	1	04	01	H5522_018_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											864.04	33						757.11	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5525	004	0	1	04	01	H5525_004_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	034	0	1	04	01	H5525_034_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	035	0	1	04	01	H5525_035_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.17	0.07		0.17	0.07	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	036	0	1	04	01	H5525_036_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	037	0	1	04	01	H5525_037_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	038	0	1	04	01	H5525_038_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	038	0	1	04	01	H5525_038_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	038	0	1	04	01	H5525_038_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	038	0	1	04	01	H5525_038_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	038	0	1	04	01	H5525_038_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	039	0	1	04	01	H5525_039_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	040	0	1	04	01	H5525_040_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	041	0	1	04	01	H5525_041_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	042	0	1	04	01	H5525_042_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	044	0	1	04	01	H5525_044_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	045	0	1	04	01	H5525_045_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	045	0	1	04	01	H5525_045_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	045	0	1	04	01	H5525_045_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	045	0	1	04	01	H5525_045_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	045	0	1	04	01	H5525_045_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	046	0	1	04	01	H5525_046_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	046	0	1	04	01	H5525_046_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	046	0	1	04	01	H5525_046_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	046	0	1	04	01	H5525_046_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	046	0	1	04	01	H5525_046_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	047	0	1	04	01	H5525_047_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	047	0	1	04	01	H5525_047_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	047	0	1	04	01	H5525_047_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	047	0	1	04	01	H5525_047_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	047	0	1	04	01	H5525_047_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	048	0	1	04	01	H5525_048_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					1.00		3.00											4.00		12.00				1.00		0.00				4.00				4.00			0.13	0.03		0.13	0.03	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	048	0	1	04	01	H5525_048_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	048	0	1	04	01	H5525_048_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	048	0	1	04	01	H5525_048_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	048	0	1	04	01	H5525_048_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	049	0	1	04	01	H5525_049_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		39.00					8.00		24.00					8.00		20.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								99.00		297.00					94.00		282.00					94.00		235.00																99.00				99.00			3.30	3.13	3.13			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		0.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		25.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					2.00		6.00					2.00		0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					4.00		12.00					4.00		0.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	020	0	1	04	01	H5526_020_0	7		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												27		27					27		27				27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		24.00					3.00		9.00					3.00		0.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					12.00		36.00					12.00		30.00																17.00				17.00			0.57	0.40	0.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					42.00		126.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					94.00		282.00					94.00		235.00																100.00				100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	021	0	1	04	01	H5526_021_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31												26		26					26		26				26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	10		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	10		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	003	0	1	04	01	H5533_003_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											716.95	33						595.84	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_0	10		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_0	10		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_0	10		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	005	0	1	04	01	H5533_005_0	10		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1065.83	33						851.98	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_0	9		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_0	9		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_0	9		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	007	0	1	04	01	H5533_007_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											757.64	33						673.06	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					0.00		0.00							0.00																15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_0	8		Y	Generic	4	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		117.50							117.50																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					100.00		300.00							300.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5533	008	0	1	04	01	H5533_008_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											567.25	33						566.29	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	8		N	Preferred Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	21.00																					21.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	8		N	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	19.00	38.00	57.00																					57.00																19.00				19.00		0.63						0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	8		N	Preferred Brand	2	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	8		N	Non-Preferred Brand	2	10	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				79.61	39	39	39																				39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5549	003	0	1	01	01	H5549_003_0	8		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	5		N	Preferred Generic	2	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								4.00		12.00					0.00		0.00											4.00		12.00				0.00		0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	5		N	Generic	2	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								9.00		27.00					9.00		27.00													9.00						27.00				9.00				9.00			0.29	0.29				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	5		N	Preferred Brand	2	10	1	1	3	1		110	01		100	1				31		100	1	2						100	31		31											121.70	25		25				121.70	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	5		N	Non-Preferred Brand	2	10	1	1	4	1		110	01		100	1				31		100	1	2						100	31		31											132.99	25		25				132.99	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	008	0	1	02	01	H5576_008_0	5		N	Specialty Tier	2	10	1	1	5	1		010	01		010	1				31								31			31		31											965.98	25						965.98	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	5		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	5		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	5		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	5		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1743.10	28						1743.10	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	5		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	5		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	5		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	5		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1743.10	28						1743.10	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	8		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	8		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	1	1	02	01	H5576_018_1	8		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	8		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	8		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	8		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1542.94	33						1542.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	7		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	2	1	02	01	H5576_018_2	7		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	7		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	7		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	7		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1542.94	33						1542.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	7		N	Preferred Generic	2	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								4.00		12.00					0.00		0.00											4.00		12.00				0.00		0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	7		N	Generic	2	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								8.00		24.00					8.00		24.00													24.00						24.00				8.00				8.00			0.26	0.26				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	7		N	Preferred Brand	2	10	1	1	3	1		110	01		100	1				31		100	1	2						100	31		31											117.26	25		25				117.26	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	7		N	Non-Preferred Brand	2	10	1	1	4	1		110	01		100	1				31		100	1	2						100	31		31											134.66	25		25				134.66	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	019	0	1	02	01	H5576_019_0	7		N	Specialty Tier	2	10	1	1	5	1		010	01		010	1				31								31			31		31											937.74	25						937.74	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	8		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	8		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								15.00		45.00					15.00		45.00													45.00						45.00				15.00				15.00			0.48	0.48				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	8		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	8		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	8		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1128.29	25						1128.29	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	6		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	6		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								15.00		45.00					15.00		45.00													45.00						45.00				15.00				15.00			0.48	0.48				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	6		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	6		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	6		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1128.29	25						1128.29	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	9		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	9		Y	Preferred Generic	4	01	1	2	1	3		110	01		110	1				31		100	1	2				31		100	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	022	0	1	02	01	H5576_022_0	9		Y	Generic	4	01	1	2	2	1		110	01		100	1				31		100	1	2						100	31		31								14.00		42.00					14.00		42.00													42.00						42.00				14.00				14.00			0.45	0.45				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	9		Y	Preferred Brand	4	10	1	2	3	1		110	01		100	1				31		100	1	2						100	31		31								47.00		141.00					47.00		141.00													141.00						141.00				47.00				47.00			1.52	1.52				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	9		Y	Non-Preferred Brand	4	10	1	2	4	1		110	01		100	1				31		100	1	2						100	31		31								100.00		300.00					100.00		300.00													300.00						300.00				100.00				100.00			3.23	3.23				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	022	0	1	02	01	H5576_022_0	9		Y	Specialty Tier	4	10	1	1	5	1		010	01		010	1				31								31			31		31											1658.79	33						1658.79	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	005	0	1	01	01	H5577_005_0	4		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4		N	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5577	005	0	1	01	01	H5577_005_0	4		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	14.00	28.00	42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				911.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	1			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4		N	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	1			90				30		31	2.00	4.00	6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	008	0	1	02	01	H5577_008_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	008	0	1	02	01	H5577_008_0	4		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4		N	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5577	008	0	1	02	01	H5577_008_0	4		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	4		N	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	031	0	1	01	01	H5577_031_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	031	0	1	01	01	H5577_031_0	4		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4		N	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5577	031	0	1	01	01	H5577_031_0	4		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	6.00	12.00	18.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	16.00	32.00	48.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				911.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	1			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	031	0	1	01	01	H5577_031_0	4		N	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	1			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	038	0	1	01	01	H5577_038_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	038	0	1	01	01	H5577_038_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	038	0	1	01	01	H5577_038_0	4		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	038	0	1	01	01	H5577_038_0	4		N	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5577	038	0	1	01	01	H5577_038_0	4		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	038	0	1	01	01	H5577_038_0	4		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	038	0	1	01	01	H5577_038_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				911.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	038	0	1	01	01	H5577_038_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	1			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	038	0	1	01	01	H5577_038_0	4		N	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	1			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	039	0	1	01	01	H5577_039_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	039	0	1	01	01	H5577_039_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5577	039	0	1	01	01	H5577_039_0	4		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	039	0	1	01	01	H5577_039_0	4		N	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	5.00	10.00	15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5577	039	0	1	01	01	H5577_039_0	4		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	039	0	1	01	01	H5577_039_0	4		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	30.00	60.00	90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	039	0	1	01	01	H5577_039_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	040	0	1	01	01	H5577_040_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	040	0	1	01	01	H5577_040_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	040	0	1	01	01	H5577_040_0	4		N	Generic	4	01	3	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	040	0	1	01	01	H5577_040_0	4		N	Generic	4	01	3	2	2	3	111		01	100		1	30	60	90				2	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5577	040	0	1	01	01	H5577_040_0	4		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	040	0	1	01	01	H5577_040_0	4		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				2	1			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	040	0	1	01	01	H5577_040_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				911.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	040	0	1	01	01	H5577_040_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	040	0	1	01	01	H5577_040_0	4		N	Select Care Drugs	4	11	1	2	6	3	111		01	100		1	30	60	90				2	1			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5590	004	0	1	01	01	H5590_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	004	0	1	01	01	H5590_004_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5590	005	0	1	01	01	H5590_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					15.00	30.00	30.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	33						0.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5590	005	0	1	01	01	H5590_005_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5590	007	0	1	01	01	H5590_007_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	007	0	1	01	01	H5590_007_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	007	0	1	01	01	H5590_007_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	007	0	1	01	01	H5590_007_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	007	0	1	01	01	H5590_007_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	008	0	1	01	01	H5590_008_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	008	0	1	01	01	H5590_008_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	008	0	1	01	01	H5590_008_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	008	0	1	01	01	H5590_008_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5590	008	0	1	01	01	H5590_008_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	1	1	02	01	H5591_006_1	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	2	1	02	01	H5591_006_2	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	006	4	1	02	01	H5591_006_4	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5591	007	0	1	01	01	H5591_007_0	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	9		Y	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5591	007	0	1	01	01	H5591_007_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	007	0	1	01	01	H5591_007_0	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	009	0	1	01	01	H5591_009_0	9		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	10		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	10		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	10		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	013	0	1	01	01	H5591_013_0	10		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5593	001	0	1	01	01	H5593_001_0	5		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5593	001	0	1	01	01	H5593_001_0	5		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5593	001	0	1	01	01	H5593_001_0	5		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5593	001	0	1	01	01	H5593_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5593	001	0	1	01	01	H5593_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				487.77	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5594	001	0	1	01	01	H5594_001_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	001	0	1	01	01	H5594_001_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	002	0	1	01	01	H5594_002_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	65.00		195.00																			65.00		130.00																65.00				65.00		2.17			2.17			1.91	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			2.79	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	019	0	1	01	01	H5594_019_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	022	0	1	01	01	H5594_022_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	026	0	1	01	01	H5594_026_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5594	028	0	1	01	01	H5594_028_0	6		Y	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	6		Y	Select Diabetic Drugs	4	10	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H5594	029	0	1	01	01	H5594_029_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	029	0	1	01	01	H5594_029_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	030	0	1	01	01	H5594_030_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5594	030	0	1	01	01	H5594_030_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	6		N	Select Diabetic Drugs	4	10	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		34	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.29	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	031	0	1	01	01	H5594_031_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	031	0	1	01	01	H5594_031_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.88	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.35	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	032	0	1	01	01	H5594_032_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.59	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.76	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		100				2	2	30		100				30		34	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	6		N	Preferred Brand	4	11	3	2	2	1	110		01	110		1	30		90				2	2	30		90				30		34	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	6		N	Non-Preferred Drug	4	11	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		34	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	6		N	Specialty Tier	4	11	1	1	4	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	001	0	1	01	01	H5599_001_0	3		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	001	0	1	01	01	H5599_001_0	3		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	001	0	1	01	01	H5599_001_0	3		N	Preferred Brand	2	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	24	24	24																		24	24	20															24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	001	0	1	01	01	H5599_001_0	3		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				100.00	39	39	39																		39	39	35															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	001	0	1	01	01	H5599_001_0	3		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	002	0	1	02	01	H5599_002_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	002	0	1	02	01	H5599_002_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	002	0	1	02	01	H5599_002_0	7		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				0.00	24	24	24																		24	24	20															24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	002	0	1	02	01	H5599_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				100.00	41	41	41																		41	41	37															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	002	0	1	02	01	H5599_002_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	003	0	1	01	01	H5599_003_0	3		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	003	0	1	01	01	H5599_003_0	3		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	003	0	1	01	01	H5599_003_0	3		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	003	0	1	01	01	H5599_003_0	3		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				97.00	50	50	50																		50	50	46															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	003	0	1	01	01	H5599_003_0	3		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	004	0	1	01	01	H5599_004_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	004	0	1	01	01	H5599_004_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	004	0	1	01	01	H5599_004_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	004	0	1	01	01	H5599_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				98.00	50	50	50																		50	50	46															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	004	0	1	01	01	H5599_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	006	0	1	01	01	H5599_006_0	3		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	006	0	1	01	01	H5599_006_0	3		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	006	0	1	01	01	H5599_006_0	3		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	006	0	1	01	01	H5599_006_0	3		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				100.00	47	47	47																		47	47	43															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	006	0	1	01	01	H5599_006_0	3		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	007	0	1	02	01	H5599_007_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	007	0	1	02	01	H5599_007_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	007	0	1	02	01	H5599_007_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	007	0	1	02	01	H5599_007_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				87.00	50	50	50																		50	50	46															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	007	0	1	02	01	H5599_007_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	008	0	1	01	01	H5599_008_0	5		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	008	0	1	01	01	H5599_008_0	5		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	008	0	1	01	01	H5599_008_0	5		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	008	0	1	01	01	H5599_008_0	5		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				96.00	50	50	50																		50	50	46															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	008	0	1	01	01	H5599_008_0	5		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	009	0	1	01	01	H5599_009_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	009	0	1	01	01	H5599_009_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	009	0	1	01	01	H5599_009_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	009	0	1	01	01	H5599_009_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				87.00	50	50	50																		50	50	46															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5599	009	0	1	01	01	H5599_009_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	5		N	Preferred Generic	4	01	1	2	1	1	111		10	100		1	30	60	90				1	2			90					10	31	3.00	6.00	6.00																					6.00																	3.00			3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5608	002	0	1	01	01	H5608_002_0	5		N	Generic	4	01	1	2	2	1	111		10	100		1	30	60	90				1	2			90					10	31	9.00	18.00	18.00																					18.00																	9.00			9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5608	002	0	1	01	01	H5608_002_0	5		N	Preferred Brand	4	10	1	1	3	1	111		10	100		1	30	60	90				1	2			90					10	31				40.30	25	25	25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5608	002	0	1	01	01	H5608_002_0	5		N	Non-Preferred Brand	4	10	1	1	4	1	111		10	100		1	30	60	90				1	2			90					10	31				36.05	50	50	50																				50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5608	002	0	1	01	01	H5608_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				294.10	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5608	002	0	1	01	01	H5608_002_0	5		N	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	90				1	2			90					10	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5619	001	0	1	01	01	H5619_001_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.50	0		0.50	0	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	021	0	1	01	01	H5619_021_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	021	0	1	01	01	H5619_021_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					35.00		105.00											47.00		141.00				35.00		70.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	041	0	1	01	01	H5619_041_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	044	0	1	01	01	H5619_044_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	044	0	1	01	01	H5619_044_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	044	0	1	01	01	H5619_044_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	044	0	1	01	01	H5619_044_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	044	0	1	01	01	H5619_044_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	045	0	1	01	01	H5619_045_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	045	0	1	01	01	H5619_045_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	045	0	1	01	01	H5619_045_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	045	0	1	01	01	H5619_045_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	045	0	1	01	01	H5619_045_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	046	0	1	01	01	H5619_046_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	046	0	1	01	01	H5619_046_0	2		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	047	0	1	01	01	H5619_047_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	047	0	1	01	01	H5619_047_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	049	0	1	01	01	H5619_049_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	050	0	1	01	01	H5619_050_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	051	0	1	01	01	H5619_051_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	052	0	1	01	01	H5619_052_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	053	0	1	01	01	H5619_053_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	054	0	1	01	01	H5619_054_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	055	0	1	01	01	H5619_055_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	055	0	1	01	01	H5619_055_0	2		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					7.00		21.00											11.00		33.00				7.00		0.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	056	0	1	01	01	H5619_056_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	056	0	1	01	01	H5619_056_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	057	0	1	01	01	H5619_057_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	8		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	8		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	059	0	1	01	01	H5619_059_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	060	0	1	01	01	H5619_060_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	061	0	1	01	01	H5619_061_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	062	0	1	01	01	H5619_062_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	5		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	063	0	1	01	01	H5619_063_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	064	0	1	01	01	H5619_064_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					2.00		6.00											19.00		57.00				2.00		0.00				19.00				19.00			0.63	0.07		0.63	0.07	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	065	0	1	01	01	H5619_065_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	066	0	1	01	01	H5619_066_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	01	01	H5619_069_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	01	01	H5619_069_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	01	01	H5619_069_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	01	01	H5619_069_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	069	0	1	01	01	H5619_069_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	071	0	1	01	01	H5619_071_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	073	0	1	01	01	H5619_073_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	075	0	1	01	01	H5619_075_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	075	0	1	01	01	H5619_075_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	075	0	1	01	01	H5619_075_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	075	0	1	01	01	H5619_075_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	075	0	1	01	01	H5619_075_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	076	0	1	01	01	H5619_076_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	076	0	1	01	01	H5619_076_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	076	0	1	01	01	H5619_076_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	076	0	1	01	01	H5619_076_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	076	0	1	01	01	H5619_076_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	077	0	1	01	01	H5619_077_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	078	0	1	01	01	H5619_078_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	080	0	1	01	01	H5619_080_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	082	0	1	01	01	H5619_082_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	083	0	1	01	01	H5619_083_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	086	0	1	01	01	H5619_086_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	086	0	1	01	01	H5619_086_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	086	0	1	01	01	H5619_086_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	086	0	1	01	01	H5619_086_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	086	0	1	01	01	H5619_086_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	087	0	1	01	01	H5619_087_0	3		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5619	088	0	1	01	01	H5619_088_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	088	0	1	01	01	H5619_088_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	089	0	1	01	01	H5619_089_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	02	01	H5619_090_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	02	01	H5619_090_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	02	01	H5619_090_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	02	01	H5619_090_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	090	0	1	02	01	H5619_090_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	02	01	H5619_091_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	02	01	H5619_091_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	02	01	H5619_091_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	02	01	H5619_091_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	091	0	1	02	01	H5619_091_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	093	0	1	01	01	H5619_093_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					2.00		6.00											2.00		6.00				2.00		0.00				2.00				2.00			0.07	0.07		0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	093	0	1	01	01	H5619_093_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	093	0	1	01	01	H5619_093_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	093	0	1	01	01	H5619_093_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	093	0	1	01	01	H5619_093_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	094	0	1	01	01	H5619_094_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	02	01	H5619_095_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	02	01	H5619_095_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	02	01	H5619_095_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	02	01	H5619_095_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	095	0	1	02	01	H5619_095_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	097	0	1	01	01	H5619_097_0	8		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	097	0	1	01	01	H5619_097_0	8		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	097	0	1	01	01	H5619_097_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	097	0	1	01	01	H5619_097_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	097	0	1	01	01	H5619_097_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	099	0	1	01	01	H5619_099_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	100	0	1	01	01	H5619_100_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	101	0	1	01	01	H5619_101_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												32							32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.00		42.00					1.00		3.00											14.00		42.00				1.00		0.00				14.00				14.00			0.47	0.03		0.47	0.03	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	109	0	1	01	01	H5619_109_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	3		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	111	0	1	01	01	H5619_111_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	112	0	1	01	01	H5619_112_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	113	0	1	01	01	H5619_113_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	114	0	1	01	01	H5619_114_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	115	0	1	01	01	H5619_115_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	116	0	1	01	01	H5619_116_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	118	0	1	01	01	H5619_118_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	118	0	1	01	01	H5619_118_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	118	0	1	01	01	H5619_118_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	118	0	1	01	01	H5619_118_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	118	0	1	01	01	H5619_118_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	2		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5619	119	0	1	01	01	H5619_119_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	2		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	119	0	1	01	01	H5619_119_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	119	0	1	01	01	H5619_119_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	122	0	1	01	01	H5619_122_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	123	0	1	01	01	H5619_123_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	124	0	1	01	01	H5619_124_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	124	0	1	01	01	H5619_124_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	124	0	1	01	01	H5619_124_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	124	0	1	01	01	H5619_124_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	124	0	1	01	01	H5619_124_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	126	0	1	01	01	H5619_126_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	126	0	1	01	01	H5619_126_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	126	0	1	01	01	H5619_126_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	126	0	1	01	01	H5619_126_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	126	0	1	01	01	H5619_126_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	128	0	1	01	01	H5619_128_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	129	0	1	01	01	H5619_129_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	129	0	1	01	01	H5619_129_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	129	0	1	01	01	H5619_129_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	129	0	1	01	01	H5619_129_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	129	0	1	01	01	H5619_129_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	1	1	01	01	H5619_130_1	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	130	2	1	01	01	H5619_130_2	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	131	0	1	01	01	H5619_131_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	1	1	01	01	H5619_132_1	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	1	1	01	01	H5619_132_1	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	1	1	01	01	H5619_132_1	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	1	1	01	01	H5619_132_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	1	1	01	01	H5619_132_1	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	2	1	01	01	H5619_132_2	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	2	1	01	01	H5619_132_2	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	2	1	01	01	H5619_132_2	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	2	1	01	01	H5619_132_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	132	2	1	01	01	H5619_132_2	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	133	0	1	01	01	H5619_133_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.17	0.07		0.17	0.07	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	134	0	1	01	01	H5619_134_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	135	0	1	01	01	H5619_135_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	5		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	1	1	01	01	H5619_136_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	2	1	01	01	H5619_136_2	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	5		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	3	1	01	01	H5619_136_3	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	6		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	6		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	136	4	1	01	01	H5619_136_4	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	137	0	1	01	01	H5619_137_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	23.00	46.00	69.00																			23.00	46.00	69.00																23.00				23.00		0.74			0.74			0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.74	41	41	41																		41	41	41															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				458.42	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.26			0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				544.20	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	007	0	1	01	01	H5628_007_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	008	0	1	01	01	H5628_008_0	4		N	Preferred Generic	2	11	1	1	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	4		N	Generic	2	11	1	1	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	4		N	Preferred Brand	2	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	4		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	008	0	1	01	01	H5628_008_0	4		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	009	0	1	01	01	H5628_009_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.19			0.19			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				541.16	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	009	0	1	01	01	H5628_009_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.19			0.19			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.23			3.23			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				485.38	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5628	010	0	1	01	01	H5628_010_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5644	002	0	1	01	01	H5644_002_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		0.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		35.00					8.00		20.00					8.00		20.00																8.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	6		N	Non-Preferred Brand	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																90.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5644	002	0	1	01	01	H5644_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5649	001	0	1	01	01	H5649_001_0	6		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	6		N	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	001	0	1	01	01	H5649_001_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	6		N	Non-Preferred Drug	4	11	3	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				697.11	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	6		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5649	002	0	1	01	01	H5649_002_0	6		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	6		N	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	002	0	1	01	01	H5649_002_0	6		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				117.20	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	6		N	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				1	2			90				30		31				59.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				571.28	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	6		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5649	004	0	1	01	01	H5649_004_0	6		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	6		N	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	004	0	1	01	01	H5649_004_0	6		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				131.57	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	6		N	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				1	2			90				30		31				46.20	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				587.01	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	6		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5649	006	0	1	01	01	H5649_006_0	6		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	6		N	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	006	0	1	01	01	H5649_006_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	6		N	Non-Preferred Drug	4	11	3	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				761.07	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	6		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	6		N	Select Care Drugs	4	10	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	008	0	1	01	01	H5649_008_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5649	008	0	1	01	01	H5649_008_0	5		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	5		N	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	008	0	1	01	01	H5649_008_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	5		N	Non-Preferred Drug	4	11	3	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				847.16	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	5		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5649	009	0	1	01	01	H5649_009_0	5		N	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	5		N	Generic	4	11	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	009	0	1	01	01	H5649_009_0	5		N	Preferred Brand	4	11	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				130.18	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	5		N	Non-Preferred Drug	4	11	3	1	4	1	110		01	100		1	30		90				1	2			90				30		31				46.98	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				717.52	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	5		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5652	001	0	1	02	01	H5652_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	001	0	1	02	01	H5652_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				269.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	003	0	1	02	01	H5652_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	28.00		84.00																											84.00						74.00				28.00				28.00		0.93						0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	70.00		210.00																											210.00						200.00				70.00				70.00		2.33						2.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				338.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	15.00		45.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	15.00		45.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	004	0	1	02	01	H5652_004_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				414.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	15.00		45.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	15.00		45.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	006	0	1	02	01	H5652_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				173.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	20.00		60.00																											60.00						0.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	20.00		60.00																											60.00						0.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H5652	008	0	1	02	01	H5652_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	008	0	1	02	01	H5652_008_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				102.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	5		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					35.00		105.00											45.00		135.00				35.00		70.00				45.00				45.00			1.5	1.17		1.5	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								85.00		255.00					75.00		225.00											85.00		255.00				75.00		150.00				85.00				85.00			2.83	2.5		2.83	2.5	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5746	016	0	1	01	01	H5746_016_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5746	018	0	1	01	01	H5746_018_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	018	0	1	01	01	H5746_018_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5774	005	0	1	01	01	H5774_005_0	13		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	13		Y	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	005	0	1	01	01	H5774_005_0	13		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	13		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	005	0	1	01	01	H5774_005_0	13		Y	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								30.00		60.00					5.00		10.00							10.00																30.00				5.00			1.00	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	13		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					15.00		30.00							30.00																55.00				15.00			1.83	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	13		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	13		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	005	0	1	01	01	H5774_005_0	13		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	022	0	1	01	01	H5774_022_0	12		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	12		Y	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	022	0	1	01	01	H5774_022_0	12		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	12		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	022	0	1	01	01	H5774_022_0	12		Y	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					5.00		10.00							10.00																20.00				5.00			0.67	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	12		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					20.00		40.00							40.00																55.00				20.00			1.83	0.67				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	12		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	12		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	022	0	1	01	01	H5774_022_0	12		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	024	0	1	01	01	H5774_024_0	11		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	11		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	11		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	11		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	11		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	024	0	1	01	01	H5774_024_0	11		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					3.00		6.00							6.00																8.00				3.00			0.27	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	12		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	12		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	12		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	12		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	12		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	025	0	1	01	01	H5774_025_0	12		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								6.00		12.00					2.00		4.00							4.00																6.00				2.00			0.20	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	12		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	12		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	12		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	12		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	12		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	026	0	1	01	01	H5774_026_0	12		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	11		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	11		Y	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	027	0	1	02	01	H5774_027_0	11		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	11		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	027	0	1	02	01	H5774_027_0	11		Y	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								30.00		60.00					8.00		16.00							16.00																30.00				8.00			1.00	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	11		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								55.00		110.00					25.00		50.00							50.00																55.00				25.00			1.83	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	11		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	11		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	027	0	1	02	01	H5774_027_0	11		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	028	0	1	01	01	H5774_028_0	11		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		30.00					10.00		20.00							20.00																15.00				10.00			0.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	11		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	11		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	11		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	11		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	028	0	1	01	01	H5774_028_0	11		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					2.00		4.00							4.00																8.00				2.00			0.27	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	11		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	11		Y	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	031	0	1	02	01	H5774_031_0	11		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	11		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	031	0	1	02	01	H5774_031_0	11		Y	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					5.00		10.00							10.00																20.00				5.00			0.67	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	11		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								45.00		90.00					10.00		20.00							20.00																45.00				10.00			1.50	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	11		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											25.00	25		25				25.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	11		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	031	0	1	02	01	H5774_031_0	11		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	032	0	1	01	01	H5774_032_0	11		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	032	0	1	01	01	H5774_032_0	11		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	032	0	1	01	01	H5774_032_0	11		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	032	0	1	01	01	H5774_032_0	11		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	032	0	1	01	01	H5774_032_0	11		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	032	0	1	01	01	H5774_032_0	11		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								6.00		12.00					2.00		4.00							4.00																6.00				2.00			0.20	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	033	0	1	01	01	H5774_033_0	11		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	033	0	1	01	01	H5774_033_0	11		Y	Preferred Generic	4	01	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		10.00					0.00		0.00							0.00																5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	033	0	1	01	01	H5774_033_0	11		Y	Generic	4	01	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	033	0	1	01	01	H5774_033_0	11		Y	Generic	4	01	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								8.00		16.00					0.00		0.00							0.00																8.00				0.00			0.27	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		3
H5774	033	0	1	01	01	H5774_033_0	11		Y	Preferred Brand	4	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					20.00		40.00							40.00																45.00				20.00			1.50	0.67				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	033	0	1	01	01	H5774_033_0	11		Y	Non-Preferred Brand	4	10	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								65.00		130.00					35.00		70.00							70.00																65.00				35.00			2.17	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	033	0	1	01	01	H5774_033_0	11		Y	Specialty Tier	4	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				33.00	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	033	0	1	01	01	H5774_033_0	11		Y	Select Care Drugs	4	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	033	0	1	01	01	H5774_033_0	11		Y	Select Care Drugs	4	11	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								3.00		6.00					0.00		0.00							0.00																3.00				0.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5774	035	0	1	01	01	H5774_035_0	11		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								19.00		38.00					14.00		28.00							28.00																19.00				14.00			0.63	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	11		N	Generic	2	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					15.00		30.00							30.00																20.00				15.00			0.67	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	11		N	Preferred Brand	2	10	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		94.00					42.00		84.00							84.00																47.00				42.00			1.57	1.40				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	11		N	Non-Preferred Brand	2	10	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		200.00					95.00		190.00							190.00																100.00				95.00			3.33	3.17				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	11		N	Specialty Tier	2	11	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31												25		25					25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5774	035	0	1	01	01	H5774_035_0	11		N	Select Care Drugs	2	11	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					2.00		4.00							4.00																10.00				2.00			0.33	0.07				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5779	002	0	1	01	01	H5779_002_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	006	0	1	01	01	H5779_006_0	7		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	006	0	1	01	01	H5779_006_0	7		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		0.00				18.00				18.00		0.6				0.6	0.6	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	006	0	1	01	01	H5779_006_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	006	0	1	01	01	H5779_006_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				73.90	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	006	0	1	01	01	H5779_006_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	007	0	1	01	01	H5779_007_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	007	0	1	01	01	H5779_007_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5779	007	0	1	01	01	H5779_007_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	007	0	1	01	01	H5779_007_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	007	0	1	01	01	H5779_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5779	007	0	1	01	01	H5779_007_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	001	0	1	01	01	H5793_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	001	0	1	01	01	H5793_001_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	001	0	1	01	01	H5793_001_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	001	0	1	01	01	H5793_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	001	0	1	01	01	H5793_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	001	0	1	01	01	H5793_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											772.92	33						554.13	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	010	0	1	01	01	H5793_010_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	010	0	1	01	01	H5793_010_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	5.00											15.00	30.00	45.00				2.00	4.00	5.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	010	0	1	01	01	H5793_010_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	010	0	1	01	01	H5793_010_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	010	0	1	01	01	H5793_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	010	0	1	01	01	H5793_010_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	010	0	1	01	01	H5793_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											901.34	33						469.04	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	012	0	1	01	01	H5793_012_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	012	0	1	01	01	H5793_012_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	012	0	1	01	01	H5793_012_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	012	0	1	01	01	H5793_012_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	012	0	1	01	01	H5793_012_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	012	0	1	01	01	H5793_012_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	012	0	1	01	01	H5793_012_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											663.57	33						518.26	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	014	0	1	01	01	H5793_014_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	014	0	1	01	01	H5793_014_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	014	0	1	01	01	H5793_014_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	014	0	1	01	01	H5793_014_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	014	0	1	01	01	H5793_014_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	014	0	1	01	01	H5793_014_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	014	0	1	01	01	H5793_014_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											706.09	28						508.19	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	015	0	1	01	01	H5793_015_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	015	0	1	01	01	H5793_015_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	015	0	1	01	01	H5793_015_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	015	0	1	01	01	H5793_015_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	015	0	1	01	01	H5793_015_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	015	0	1	01	01	H5793_015_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	015	0	1	01	01	H5793_015_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											752.53	33						553.11	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	016	0	1	01	01	H5793_016_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	016	0	1	01	01	H5793_016_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	016	0	1	01	01	H5793_016_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	016	0	1	01	01	H5793_016_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	016	0	1	01	01	H5793_016_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	016	0	1	01	01	H5793_016_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	016	0	1	01	01	H5793_016_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											832.88	33						607.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	017	0	1	02	01	H5793_017_0	5		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	017	0	1	02	01	H5793_017_0	5		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	017	0	1	02	01	H5793_017_0	5		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	017	0	1	02	01	H5793_017_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	017	0	1	02	01	H5793_017_0	5		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				510.37	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	018	0	1	01	01	H5793_018_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					3.00	6.00	0.00											15.00	30.00	45.00				3.00	6.00	0.00					15.00			15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	018	0	1	01	01	H5793_018_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					3.00	6.00	0.00											15.00	30.00	45.00				3.00	6.00	0.00					15.00			15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	018	0	1	01	01	H5793_018_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	14.00											20.00	40.00	60.00				7.00	14.00	14.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	018	0	1	01	01	H5793_018_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					7.00	14.00	14.00											20.00	40.00	60.00				7.00	14.00	14.00					20.00			20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	018	0	1	01	01	H5793_018_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	018	0	1	01	01	H5793_018_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5793	018	0	1	01	01	H5793_018_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											681.30	28						491.97	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H5810	001	0	1	01	01	H5810_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.45			0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				96.72	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				542.17	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.45			0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.29			1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.45	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	013	0	1	01	01	H5810_013_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				535.72	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	29.00	58.00	87.00																			29.00	58.00	87.00																29.00				29.00		0.94			0.94			0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.42	44	44	44																		44	44	44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				456.11	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	140.00					42.00	84.00	125.00					42.00	84.00	125.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											99.80	50	50	50				96.12	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	140.00					42.00	84.00	125.00					42.00	84.00	125.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											74.64	50	50	50				67.82	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	140.00					42.00	84.00	125.00					42.00	84.00	125.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											62.22	50	50	50				61.53	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								15.00	30.00	30.00					10.00	20.00	20.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31								47.00	94.00	140.00					42.00	84.00	125.00					42.00	84.00	125.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	1	30	60	90				30		31											86.32	50	50	50				92.40	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	016	0	1	01	01	H5826_016_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5828	001	0	1	01	01	H5828_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	001	0	1	01	01	H5828_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	001	0	1	01	01	H5828_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	001	0	1	01	01	H5828_001_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	002	0	1	01	01	H5828_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	002	0	1	01	01	H5828_002_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	002	0	1	01	01	H5828_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	002	0	1	01	01	H5828_002_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	005	0	1	02	01	H5828_005_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	005	0	1	02	01	H5828_005_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	16.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	005	0	1	02	01	H5828_005_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	005	0	1	02	01	H5828_005_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	005	0	1	02	01	H5828_005_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	005	0	1	02	01	H5828_005_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	005	0	1	02	01	H5828_005_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	006	0	1	02	01	H5828_006_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	006	0	1	02	01	H5828_006_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	16.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	006	0	1	02	01	H5828_006_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	006	0	1	02	01	H5828_006_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	006	0	1	02	01	H5828_006_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	006	0	1	02	01	H5828_006_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	006	0	1	02	01	H5828_006_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	007	0	1	01	01	H5828_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	007	0	1	01	01	H5828_007_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	007	0	1	01	01	H5828_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	007	0	1	01	01	H5828_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	007	0	1	01	01	H5828_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	007	0	1	01	01	H5828_007_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	007	0	1	01	01	H5828_007_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	008	0	1	01	01	H5828_008_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5828	008	0	1	01	01	H5828_008_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00	27.00	27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	270.00	270.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5828	008	0	1	01	01	H5828_008_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5841	001	0	1	04	01	H5841_001_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	001	0	1	04	01	H5841_001_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	001	0	1	04	01	H5841_001_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	001	0	1	04	01	H5841_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	001	0	1	04	01	H5841_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				707.05	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	001	0	1	04	01	H5841_001_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	001	0	1	04	01	H5841_001_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5841	002	0	1	04	01	H5841_002_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	002	0	1	04	01	H5841_002_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	002	0	1	04	01	H5841_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	002	0	1	04	01	H5841_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	002	0	1	04	01	H5841_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				741.45	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	002	0	1	04	01	H5841_002_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	002	0	1	04	01	H5841_002_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5841	003	0	1	04	01	H5841_003_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	003	0	1	04	01	H5841_003_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	003	0	1	04	01	H5841_003_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	003	0	1	04	01	H5841_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	003	0	1	04	01	H5841_003_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				747.62	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	003	0	1	04	01	H5841_003_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	003	0	1	04	01	H5841_003_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5841	004	0	1	04	01	H5841_004_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	004	0	1	04	01	H5841_004_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	004	0	1	04	01	H5841_004_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	004	0	1	04	01	H5841_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	004	0	1	04	01	H5841_004_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				736.29	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	004	0	1	04	01	H5841_004_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	004	0	1	04	01	H5841_004_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5841	005	0	1	04	01	H5841_005_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	005	0	1	04	01	H5841_005_0	5		N	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					13.00		39.00					13.00		26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	005	0	1	04	01	H5841_005_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		120.00					40.00		80.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	005	0	1	04	01	H5841_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					93.00		279.00					93.00		186.00																100.00				100.00			3.33	3.1	3.1			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	005	0	1	04	01	H5841_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											618.56	25						618.56	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	005	0	1	04	01	H5841_005_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	005	0	1	04	01	H5841_005_0	5		N	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5841	010	0	1	04	01	H5841_010_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	010	0	1	04	01	H5841_010_0	5		N	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					13.00		39.00					13.00		26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	010	0	1	04	01	H5841_010_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		120.00					40.00		80.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	010	0	1	04	01	H5841_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					93.00		279.00					93.00		186.00																100.00				100.00			3.33	3.1	3.1			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	010	0	1	04	01	H5841_010_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											582.19	25						582.19	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	010	0	1	04	01	H5841_010_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5841	010	0	1	04	01	H5841_010_0	5		N	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5843	001	0	1	01	01	H5843_001_0	9		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	2.00		6.00																					4.00																2.00				2.00		.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	001	0	1	01	01	H5843_001_0	9		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5843	001	0	1	01	01	H5843_001_0	9		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	12.00		36.00																					24.00																12.00				12.00		.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	001	0	1	01	01	H5843_001_0	9		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	001	0	1	01	01	H5843_001_0	9		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					300.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	001	0	1	01	01	H5843_001_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	001	0	1	01	01	H5843_001_0	9		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	001	0	1	01	01	H5843_001_0	9		N	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5843	002	0	1	01	01	H5843_002_0	9		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	2.00		6.00																					4.00																2.00				2.00		.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	002	0	1	01	01	H5843_002_0	9		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5843	002	0	1	01	01	H5843_002_0	9		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	12.00		36.00																					24.00																12.00				12.00		.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	002	0	1	01	01	H5843_002_0	9		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	002	0	1	01	01	H5843_002_0	9		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					300.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	002	0	1	01	01	H5843_002_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31					29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	002	0	1	01	01	H5843_002_0	9		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5843	002	0	1	01	01	H5843_002_0	9		N	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5852	001	0	1	01	01	H5852_001_0	4		N	Generic	4	01	1	1	1	1	110		01			1	30		90				1	2							30		34				8.94	15		15																																			15			15								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5852	001	0	1	01	01	H5852_001_0	4		N	Preferred Brand	4	11	1	1	2	1	110		01			1	30		90				1	2							30		34				14.83	15		15																																			15			15								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5852	001	0	1	01	01	H5852_001_0	4		N	Non-Preferred Brand	4	10	1	1	3	1	110		01			1	30		90				1	1							30		34				100.09	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5852	001	0	1	01	01	H5852_001_0	4		N	Specialty Tier	4	10	1	1	4	1	110		01			1	30		90				1	1							30		34				731.54	25		25																																			25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5852	001	0	1	01	01	H5852_001_0	4		N	Select Care Drugs	4	01	1	1	5	1	110		01			1	30		90				1	2							30		34				0.00	0		0																																			0			0								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5852	001	0	1	01	01	H5852_001_0	4		N	Select Care Drugs	4	01	1	1	5	3	110		01			1	30		90				1	2							30		34				0.00	0		0																																			0			0								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5854	007	0	1	01	01	H5854_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	123.00	123.00																46.00				46.00			1.53	1.37	1.37			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	008	0	1	01	01	H5854_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	008	0	1	01	01	H5854_008_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					20.00	40.00	60.00					20.00	60.00	60.00																20.00				20.00			0.67	0.67	0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	009	0	1	01	01	H5854_009_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	010	0	1	01	01	H5854_010_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	123.00	123.00																46.00				46.00			1.53	1.37	1.37			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	011	0	1	01	01	H5854_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	011	0	1	01	01	H5854_011_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								8.00	16.00	24.00					8.00	16.00	24.00					8.00	24.00	24.00																8.00				8.00			0.27	0.27	0.27			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	011	0	1	01	01	H5854_011_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	012	0	1	02	01	H5854_012_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	012	0	1	02	01	H5854_012_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	013	0	1	01	01	H5854_013_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								19.00	38.00	57.00					19.00	38.00	57.00					19.00	57.00	57.00																19.00				19.00			0.63	0.63	0.63			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	013	0	1	01	01	H5854_013_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	014	0	1	01	01	H5854_014_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	014	0	1	01	01	H5854_014_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	014	0	1	01	01	H5854_014_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	014	0	1	01	01	H5854_014_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H5854	015	0	1	01	01	H5854_015_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	015	0	1	01	01	H5854_015_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								5.00	10.00	15.00					5.00	10.00	15.00					5.00	10.00	10.00																5.00				5.00			0.17	0.17	0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	015	0	1	01	01	H5854_015_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5859	001	0	1	02	01	H5859_001_0	8		N	Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				6.81	25	25	25																		25	25	25															25			25								Generic, Brand												
H5859	001	0	1	02	01	H5859_001_0	8		N	Brand	4	10	1	1	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				121.08	25	25	25																		25	25	24															25			25								Generic, Brand												
H5883	002	1	1	02	01	H5883_002_1	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				73.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	1	1	02	01	H5883_002_1	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	002	2	1	02	01	H5883_002_2	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				73.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	2	1	02	01	H5883_002_2	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	002	3	1	02	01	H5883_002_3	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				73.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	3	1	02	01	H5883_002_3	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	002	4	1	02	01	H5883_002_4	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				73.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	4	1	02	01	H5883_002_4	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	002	7	1	02	01	H5883_002_7	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											78.00	45		45				73.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	002	7	1	02	01	H5883_002_7	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	003	1	1	02	01	H5883_003_1	9		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	9		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	9		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	9		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	45		45				83.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	9		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	9		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	1	1	02	01	H5883_003_1	9		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	003	2	1	02	01	H5883_003_2	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	45		45				83.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	2	1	02	01	H5883_003_2	7		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	003	3	1	02	01	H5883_003_3	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	45		45				83.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	3	1	02	01	H5883_003_3	7		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	003	4	1	02	01	H5883_003_4	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	45		45				83.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	4	1	02	01	H5883_003_4	7		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	003	5	1	02	01	H5883_003_5	7		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	7		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	7		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								43.00		129.00					38.00		114.00											43.00		129.00				38.00		114.00				43.00				43.00			1.39	1.23		1.39	1.23	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	7		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											74.00	45		45				83.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	7		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	7		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	003	5	1	02	01	H5883_003_5	7		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	007	0	1	01	01	H5883_007_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		0.00											7.00		21.00				1.00		0.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		0.00											18.00		54.00				10.00		0.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											82.00	48		48				83.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	007	0	1	01	01	H5883_007_0	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	012	1	1	02	01	H5883_012_1	5		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.26	0.00		0.26	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	5		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					10.00		0.00											20.00		60.00				10.00		0.00				20.00				20.00			0.65	0.32		0.65	0.32	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		135.00				47.00				47.00			1.52	1.45		1.52	1.45	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											86.00	50		50				86.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	1	1	02	01	H5883_012_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.26	0.00		0.26	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					10.00		0.00											20.00		60.00				10.00		0.00				20.00				20.00			0.65	0.32		0.65	0.32	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		135.00				47.00				47.00			1.52	1.45		1.52	1.45	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											86.00	50		50				86.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	012	2	1	02	01	H5883_012_2	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		0.00											9.00		27.00				3.00		0.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											94.00	50		50				96.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	32						1.00	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	1	1	02	01	H5883_014_1	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	014	2	1	02	01	H5883_014_2	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		0.00											9.00		27.00				3.00		0.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	2	1	02	01	H5883_014_2	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	2	1	02	01	H5883_014_2	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	2	1	02	01	H5883_014_2	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											94.00	50		50				96.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	2	1	02	01	H5883_014_2	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	32						1.00	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	2	1	02	01	H5883_014_2	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	2	1	02	01	H5883_014_2	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	014	3	1	02	01	H5883_014_3	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		0.00											9.00		27.00				3.00		0.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	3	1	02	01	H5883_014_3	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	3	1	02	01	H5883_014_3	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	3	1	02	01	H5883_014_3	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											94.00	50		50				96.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	3	1	02	01	H5883_014_3	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	32						1.00	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	3	1	02	01	H5883_014_3	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	3	1	02	01	H5883_014_3	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	014	4	1	02	01	H5883_014_4	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		0.00											9.00		27.00				3.00		0.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	4	1	02	01	H5883_014_4	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	4	1	02	01	H5883_014_4	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	4	1	02	01	H5883_014_4	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											94.00	50		50				96.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	4	1	02	01	H5883_014_4	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	32						1.00	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	4	1	02	01	H5883_014_4	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	4	1	02	01	H5883_014_4	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5883	014	5	1	02	01	H5883_014_5	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								9.00		27.00					3.00		0.00											9.00		27.00				3.00		0.00				9.00				9.00			0.29	0.10		0.29	0.10	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	5	1	02	01	H5883_014_5	5		Y	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	5	1	02	01	H5883_014_5	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	5	1	02	01	H5883_014_5	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											94.00	50		50				96.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	5	1	02	01	H5883_014_5	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	32						1.00	32												32						32					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	5	1	02	01	H5883_014_5	5		Y	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5883	014	5	1	02	01	H5883_014_5	5		Y	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5926	001	0	1	01	01	H5926_001_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.97	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				597.51	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	004	0	1	01	01	H5926_004_0	6		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	004	0	1	01	01	H5926_004_0	6		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	004	0	1	01	01	H5926_004_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	004	0	1	01	01	H5926_004_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				95.00	32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	004	0	1	01	01	H5926_004_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				597.51	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								5.00	5.00	5.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	8		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								10.00	20.00	25.00					3.00	6.00	7.50							7.50																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	8		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								10.00	20.00	25.00					3.00	6.00	7.50							7.50																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	117.50					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	250.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	005	0	1	01	01	H5928_005_0	8		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				2	2			90				30		31				5.69	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				94.50	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				72.61	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	005	0	1	01	01	H5928_005_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				603.47	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	010	0	1	01	01	H5928_010_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								10.00	20.00	25.00					5.00	10.00	12.50							12.50																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								10.00	20.00	25.00					5.00	10.00	12.50							12.50																10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	010	0	1	01	01	H5928_010_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	117.50					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	250.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	30.00					5.00	10.00	12.50							12.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	30.00					5.00	10.00	12.50							12.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	117.50					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	250.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	037	0	1	01	01	H5928_037_0	6		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				2	2			90				30		31				5.76	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	6		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				95.49	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				73.82	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				623.66	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	044	0	1	01	01	H5928_044_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	30.00					5.00	10.00	12.50							12.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	30.00					5.00	10.00	12.50							12.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	044	0	1	01	01	H5928_044_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	117.50					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	250.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	050	0	1	01	01	H5928_050_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	050	0	1	01	01	H5928_050_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	050	0	1	01	01	H5928_050_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	30.00					5.00	10.00	12.50							12.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	050	0	1	01	01	H5928_050_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								12.00	24.00	30.00					5.00	10.00	12.50							12.50																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	050	0	1	01	01	H5928_050_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	117.50					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	050	0	1	01	01	H5928_050_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	250.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	050	0	1	01	01	H5928_050_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											725.92	29						725.92	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	051	0	1	01	01	H5928_051_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	051	0	1	01	01	H5928_051_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	051	0	1	01	01	H5928_051_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	42.50					10.00	20.00	25.00							25.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	051	0	1	01	01	H5928_051_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	42.50					10.00	20.00	25.00							25.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	051	0	1	01	01	H5928_051_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	117.50					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	051	0	1	01	01	H5928_051_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	250.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	051	0	1	01	01	H5928_051_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	052	0	1	01	01	H5928_052_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	052	0	1	01	01	H5928_052_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	052	0	1	01	01	H5928_052_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	42.50					10.00	20.00	25.00							25.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	052	0	1	01	01	H5928_052_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	42.50					10.00	20.00	25.00							25.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	052	0	1	01	01	H5928_052_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	117.50					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	052	0	1	01	01	H5928_052_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	250.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	052	0	1	01	01	H5928_052_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	053	0	1	01	01	H5928_053_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	053	0	1	01	01	H5928_053_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	100		1				30	60	100	2	2			100				30		31								3.00	3.00	3.00					0.00	0.00	0.00							0.00																3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	053	0	1	01	01	H5928_053_0	6		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	42.50					10.00	20.00	25.00							25.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	053	0	1	01	01	H5928_053_0	6		N	Generic	4	01	1	2	2	3		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	42.50					10.00	20.00	25.00							25.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	053	0	1	01	01	H5928_053_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	117.50					40.00	80.00	100.00							100.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	053	0	1	01	01	H5928_053_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								100.00	200.00	250.00					95.00	190.00	237.50							237.50																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	053	0	1	01	01	H5928_053_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	100		1	30	60	100				2	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	054	0	1	01	01	H5928_054_0	5		N	Generic	4	01	1	1	2	1	111		01	100		1	30	60	90				2	2			90				30		31				5.66	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Preferred Brand	4	11	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				93.62	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				71.47	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	054	0	1	01	01	H5928_054_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				615.58	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	12		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	12		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	12		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	38.00	76.00	114.00																			38.00	76.00	114.00																38.00				38.00		1.27			1.27			1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	12		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.36	49	49	49																		49	49	49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	001	0	1	01	01	H5932_001_0	12		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				477.25	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	13		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	13		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	13		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	13		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.57	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	009	0	1	01	01	H5932_009_0	13		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				484.25	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	6		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	6		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	001	0	1	01	01	H5938_001_0	6		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	6		Y	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	001	0	1	01	01	H5938_001_0	6		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	6		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	6		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	6		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	001	0	1	01	01	H5938_001_0	6		Y	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	006	0	1	01	01	H5938_006_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	006	0	1	01	01	H5938_006_0	7		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	7		Y	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	006	0	1	01	01	H5938_006_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	7		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	006	0	1	01	01	H5938_006_0	7		Y	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5938	008	0	1	01	01	H5938_008_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5938	008	0	1	01	01	H5938_008_0	8		Y	Select Care Drugs	4	01	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5943	001	0	1	02	01	H5943_001_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	001	0	1	02	01	H5943_001_0	7		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	001	0	1	02	01	H5943_001_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											67.04	25	25	25				67.04	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	001	0	1	02	01	H5943_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											72.16	25	25	25				72.16	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	001	0	1	02	01	H5943_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								3.00	6.00	9.00					0.00	0.00	0.00											3.00	6.00	9.00				0.00	0.00	0.00				3.00				3.00			0.10	0.00		0.10	0.00	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8		N	Generic	4	11	1	1	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											5.88	25	25	25				5.88	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											56.41	25	25	25				56.41	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31											79.99	25	25	25				79.99	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5943	002	0	1	02	01	H5943_002_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5945	001	0	1	01	01	H5945_001_0	8		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	8		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5945	001	0	1	01	01	H5945_001_0	8		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	8		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5945	001	0	1	01	01	H5945_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	35.00	70.00	105.00																					105.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	8		Y	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	8		Y	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5945	002	0	1	01	01	H5945_002_0	9		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5945	002	0	1	01	01	H5945_002_0	9		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5945	002	0	1	01	01	H5945_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	35.00	70.00	105.00																					105.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9		Y	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	002	0	1	01	01	H5945_002_0	9		Y	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5945	008	0	1	01	01	H5945_008_0	11		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	11		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H5945	008	0	1	01	01	H5945_008_0	11		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	11		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5945	008	0	1	01	01	H5945_008_0	11		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	20.00	40.00	60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	97.00	194.00	291.00																					281.00																97.00				97.00		3.23						3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	11		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	11		Y	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	008	0	1	01	01	H5945_008_0	11		Y	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5959	009	0	1	04	01	H5959_009_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								15.00	30.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				15.00			0.48	0.00	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	009	0	1	04	01	H5959_009_0	9		N	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								20.00	40.00	40.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.65	0.32	0.32			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	009	0	1	04	01	H5959_009_0	9		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								47.00	94.00	94.00					37.00	74.00	74.00					37.00	74.00	74.00																47.00				47.00			1.52	1.19	1.19			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	009	0	1	04	01	H5959_009_0	9		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											76.93	50	50	50				74.72	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	009	0	1	04	01	H5959_009_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												27	27	27					27	27	27				27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	9		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								13.00	26.00	26.00					0.00	0.00	0.00					0.00	0.00	0.00																13.00				13.00			0.42	0.00	0.00			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	9		Y	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								19.00	38.00	38.00					9.00	18.00	18.00					9.00	18.00	18.00																19.00				19.00			0.61	0.29	0.29			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								47.00	94.00	94.00					37.00	74.00	74.00					37.00	74.00	74.00																47.00				47.00			1.52	1.19	1.19			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	9		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											61.47	50	50	50				61.08	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	1	1	04	01	H5959_010_1	9		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	9		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								13.00	26.00	26.00					0.00	0.00	0.00					0.00	0.00	0.00																13.00				13.00			0.42	0.00	0.00			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	9		Y	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								19.00	38.00	38.00					9.00	18.00	18.00					9.00	18.00	18.00																19.00				19.00			0.61	0.29	0.29			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								47.00	94.00	94.00					37.00	74.00	74.00					37.00	74.00	74.00																47.00				47.00			1.52	1.19	1.19			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	9		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											61.47	50	50	50				61.08	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	010	2	1	04	01	H5959_010_2	9		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								13.00	26.00	26.00					0.00	0.00	0.00					0.00	0.00	0.00																13.00				13.00			0.42	0.00	0.00			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	8		Y	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								19.00	38.00	38.00					9.00	18.00	18.00					9.00	18.00	18.00																19.00				19.00			0.61	0.29	0.29			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								47.00	94.00	94.00					37.00	74.00	74.00					37.00	74.00	74.00																47.00				47.00			1.52	1.19	1.19			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											64.09	50	50	50				48.85	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	011	0	1	04	01	H5959_011_0	8		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												33	33	33					33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	012	0	1	04	01	H5959_012_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	012	0	1	04	01	H5959_012_0	8		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	012	0	1	04	01	H5959_012_0	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				49.46	21	21	21																		21	21	21															21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	012	0	1	04	01	H5959_012_0	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				74.93	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	012	0	1	04	01	H5959_012_0	8		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	1	1	04	01	H5959_013_1	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	1	1	04	01	H5959_013_1	8		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	1	1	04	01	H5959_013_1	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				46.89	21	21	21																		21	21	21															21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	1	1	04	01	H5959_013_1	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				83.05	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	1	1	04	01	H5959_013_1	8		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Generic	4	01	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	13.00	26.00	26.00																			13.00	26.00	26.00																13.00				13.00		0.42			0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Preferred Brand	4	11	1	1	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				46.89	21	21	21																		21	21	21															21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				83.05	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	013	2	1	04	01	H5959_013_2	8		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								15.00	30.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				15.00			0.48	0.00	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	8		N	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								20.00	40.00	40.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.65	0.32	0.32			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								47.00	94.00	94.00					37.00	74.00	74.00					37.00	74.00	74.00																47.00				47.00			1.52	1.19	1.19			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											63.61	50	50	50				86.50	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	1	1	04	01	H5959_014_1	8		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												27	27	27					27	27	27				27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								15.00	30.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				15.00			0.48	0.00	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	8		N	Generic	4	01	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								20.00	40.00	40.00					10.00	20.00	20.00					10.00	20.00	20.00																20.00				20.00			0.65	0.32	0.32			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								47.00	94.00	94.00					37.00	74.00	74.00					37.00	74.00	74.00																47.00				47.00			1.52	1.19	1.19			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	8		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											63.61	50	50	50				86.50	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5959	014	2	1	04	01	H5959_014_2	8		N	Specialty Tier	4	11	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												27	27	27					27	27	27				27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	001	0	1	04	01	H5965_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	001	0	1	04	01	H5965_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	001	0	1	04	01	H5965_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	001	0	1	04	01	H5965_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	001	0	1	04	01	H5965_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	002	0	1	04	01	H5965_002_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	002	0	1	04	01	H5965_002_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	002	0	1	04	01	H5965_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	002	0	1	04	01	H5965_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5965	002	0	1	04	01	H5965_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	015	0	1	04	01	H5970_015_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	018	0	1	04	01	H5970_018_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	019	0	1	04	01	H5970_019_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.50	0		0.50	0	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	020	0	1	04	01	H5970_020_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	1	1	04	01	H5970_024_1	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	024	2	1	04	01	H5970_024_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5989	011	0	1	01	01	H5989_011_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5989	011	0	1	01	01	H5989_011_0	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	10.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5989	011	0	1	01	01	H5989_011_0	9		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	47.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5989	011	0	1	01	01	H5989_011_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	100.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5989	011	0	1	01	01	H5989_011_0	9		Y	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					26	26	26																		26	26	26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	009	0	1	01	01	H5991_009_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	009	0	1	01	01	H5991_009_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	38.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	009	0	1	01	01	H5991_009_0	8		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	009	0	1	01	01	H5991_009_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	009	0	1	01	01	H5991_009_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	1	1	01	01	H6067_001_1	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	1	1	01	01	H6067_001_1	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	1	1	01	01	H6067_001_1	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	1	1	01	01	H6067_001_1	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	1	1	01	01	H6067_001_1	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	001	2	1	01	01	H6067_001_2	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6067	002	1	1	01	01	H6067_002_1	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	1	1	01	01	H6067_002_1	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	10		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6067	002	2	1	01	01	H6067_002_2	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6067	002	2	1	01	01	H6067_002_2	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6080	001	0	1	48	05	H6080_001_0	3			Generic Drugs	4	01			1	1	110		01	100		1	30		90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6080	001	0	1	48	05	H6080_001_0	3			Brand Drugs	4	10			2	1	110		01	100		1	30		90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6080	001	0	1	48	05	H6080_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	100		1	30		90				1	1			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6121	003	0	1	01	01	H6121_003_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																0.00				0.00			0.27	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	003	0	1	01	01	H6121_003_0	5		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.35	25		25				7.35	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	003	0	1	01	01	H6121_003_0	5		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											108.52	25		25				108.52	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	003	0	1	01	01	H6121_003_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											60.87	25		25				60.87	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	003	0	1	01	01	H6121_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											570.73	25						570.73	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	003	0	1	01	01	H6121_003_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	003	0	1	01	01	H6121_003_0	5		N	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6121	008	0	1	01	01	H6121_008_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	4		N	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								16.00		32.00					8.00		16.00					8.00		16.00																16.00				16.00			0.53	0.27	0.27			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					39.00		78.00					39.00		78.00																47.00				47.00			1.57	1.3	1.3			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					92.00		184.00					92.00		184.00																100.00				100.00			3.33	3.07	3.07			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											741.01	33						741.01	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	4		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6121	008	0	1	01	01	H6121_008_0	4		N	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6154	001	0	1	02	01	H6154_001_0	5		N	Preferred Generic	3	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					5.00		15.00							0.00																15.00				5.00			0.50	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	5		N	Generic	3	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					14.00		42.00							32.00																20.00				14.00			0.67	0.47				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	5		N	Preferred Brand	3	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	5		N	Non-Preferred Drug	3	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											97.90	50		50				85.70	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	001	0	1	02	01	H6154_001_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	5		N	Preferred Generic	3	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							0.00																15.00				6.00			0.50	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	5		N	Generic	3	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					11.00		33.00							23.00																20.00				11.00			0.67	0.37				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	5		N	Preferred Brand	3	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	5		N	Non-Preferred Drug	3	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											97.28	50		50				81.08	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	002	0	1	02	01	H6154_002_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	003	0	1	01	01	H6154_003_0	7		Y	Preferred Generic	4	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	003	0	1	01	01	H6154_003_0	7		Y	Generic	4	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					36.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	003	0	1	01	01	H6154_003_0	7		Y	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	42.00		126.00																					126.00																42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	003	0	1	01	01	H6154_003_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				54.96	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	003	0	1	01	01	H6154_003_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	004	0	1	01	01	H6154_004_0	6		N	Preferred Generic	3	11	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	004	0	1	01	01	H6154_004_0	6		N	Generic	3	11	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					36.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	004	0	1	01	01	H6154_004_0	6		N	Preferred Brand	3	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	42.00		126.00																					126.00																42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	004	0	1	01	01	H6154_004_0	6		N	Non-Preferred Drug	3	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				51.68	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6154	004	0	1	01	01	H6154_004_0	6		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6158	001	0	1	01	01	H6158_001_0	10		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	10		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	7.00		14.00																			7.00		0.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	10		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	10		Y	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	10		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	001	0	1	01	01	H6158_001_0	10		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6158	002	0	1	01	01	H6158_002_0	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	4.00		6.00																			4.00		0.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	002	0	1	01	01	H6158_002_0	9		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	8.00		16.00																			8.00		0.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	002	0	1	01	01	H6158_002_0	9		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	002	0	1	01	01	H6158_002_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		100				1	2	30		100				30		31	100.00		300.00																			100.00		300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	002	0	1	01	01	H6158_002_0	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	29		29																		29		29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	002	0	1	01	01	H6158_002_0	9		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6158	002	0	1	01	01	H6158_002_0	9		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H6202	001	0	1	04	01	H6202_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	34.00					2.00	4.00	4.00					2.00	4.00	0.00																12.00				2.00			0.40	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	001	0	1	04	01	H6202_001_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	52.00					8.00	16.00	22.00					8.00	16.00	0.00																18.00				8.00			0.60	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	001	0	1	04	01	H6202_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	139.00					37.00	74.00	109.00					37.00	74.00	111.00																47.00				37.00			1.57	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	001	0	1	04	01	H6202_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	194.00	290.00					100.00	194.00	290.00					100.00	194.00	290.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	001	0	1	04	01	H6202_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											37.00	28						37.00	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	002	0	1	04	01	H6202_002_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					0.00	0.00	0.00					2.00	4.00	0.00																6.00				0.00			0.20	0.00	0.07			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	002	0	1	04	01	H6202_002_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					6.00	12.00	14.00					8.00	16.00	0.00																14.00				6.00			0.47	0.20	0.27			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	002	0	1	04	01	H6202_002_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	139.00					37.00	74.00	109.00					37.00	74.00	111.00																47.00				37.00			1.57	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	002	0	1	04	01	H6202_002_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	194.00	290.00					100.00	194.00	290.00					100.00	194.00	290.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6202	002	0	1	04	01	H6202_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											37.00	29						37.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6229	005	0	1	48	05	H6229_005_0	7			Generic Drugs	4	11			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	7			Brand Drugs	4	11			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	7			Non-Medicare Rx Drugs	4	11			3	1	010		10			1	31															10	34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	7			Non-Medicare OTC Drugs	4	11			4	1	010		10			1	31															10	34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	8			Generic Drugs	4	11			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	8			Brand Drugs	4	11			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	9.20			0.00	9.20	0.00	9.20			
H6229	006	0	1	48	05	H6229_006_0	8			Non-Medicare Rx Drugs	4	11			3	1	010		10			1	31															10	34																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	8			Non-Medicare OTC Drugs	4	11			4	1	010		10			1	31															10	34																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6237	007	1	1	01	01	H6237_007_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	1	1	01	01	H6237_007_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	1	1	01	01	H6237_007_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	1	1	01	01	H6237_007_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	1	1	01	01	H6237_007_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	2	1	01	01	H6237_007_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	2	1	01	01	H6237_007_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	2	1	01	01	H6237_007_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	2	1	01	01	H6237_007_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	2	1	01	01	H6237_007_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	3	1	01	01	H6237_007_3	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	3	1	01	01	H6237_007_3	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								19.00	38.00	38.00					12.00	24.00	24.00					12.00	24.00	24.00																19.00				19.00			0.63	0.40	0.40			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	3	1	01	01	H6237_007_3	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	3	1	01	01	H6237_007_3	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	007	3	1	01	01	H6237_007_3	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											824.06	29						824.06	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	1	1	01	01	H6237_008_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	1	1	01	01	H6237_008_1	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	1	1	01	01	H6237_008_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	1	1	01	01	H6237_008_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	1	1	01	01	H6237_008_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	2	1	01	01	H6237_008_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	2	1	01	01	H6237_008_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	2	1	01	01	H6237_008_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	2	1	01	01	H6237_008_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	2	1	01	01	H6237_008_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	3	1	01	01	H6237_008_3	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								10.00	20.00	20.00					3.00	6.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.10	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	3	1	01	01	H6237_008_3	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								15.00	30.00	30.00					8.00	16.00	16.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	3	1	01	01	H6237_008_3	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	3	1	01	01	H6237_008_3	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	100	1	2	30	60	100				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6237	008	3	1	01	01	H6237_008_3	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											880.89	31						880.89	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	005	0	1	01	01	H6306_005_0	7		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	1	1	02	01	H6306_011_1	4		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	1	1	02	01	H6306_011_1	4		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	011	1	1	02	01	H6306_011_1	4		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	1	1	02	01	H6306_011_1	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	1	1	02	01	H6306_011_1	4		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.29	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	1	1	02	01	H6306_011_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				339.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	4		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	4		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	011	3	1	02	01	H6306_011_3	4		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	4		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.29	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	011	3	1	02	01	H6306_011_3	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				339.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	0.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	0.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	012	1	1	02	01	H6306_012_1	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	1	1	02	01	H6306_012_1	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				648.44	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	5		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	0.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	5		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	0.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	012	5	1	02	01	H6306_012_5	5		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	5		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	012	5	1	02	01	H6306_012_5	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				648.44	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	013	0	1	02	01	H6306_013_0	5		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	250.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	013	0	1	02	01	H6306_013_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				638.04	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6306	014	0	1	02	01	H6306_014_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.31	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6306	014	0	1	02	01	H6306_014_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				309.04	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6316	001	0	1	01	01	H6316_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6316	001	0	1	01	01	H6316_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	001	0	1	01	01	H6316_001_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6316	002	0	1	01	01	H6316_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6316	002	0	1	01	01	H6316_002_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6316	002	0	1	01	01	H6316_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6316	002	0	1	01	01	H6316_002_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6328	001	0	1	04	01	H6328_001_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8		Y	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6328	001	0	1	04	01	H6328_001_0	8		Y	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8		Y	Generic	4	11	1	2	2	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	001	0	1	04	01	H6328_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8		Y	Preferred Brand	4	11	1	2	3	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	001	0	1	04	01	H6328_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	85.00	170.00	170.00																			85.00	170.00	170.00																	85.00			85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				2366.69	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	2.00	4.00	4.00																			2.00	4.00	4.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	2.00	4.00	4.00																			2.00	4.00	4.00																	2.00			2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6328	002	0	1	04	01	H6328_002_0	7		Y	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12.00	24.00	24.00																			12.00	24.00	24.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7		Y	Generic	4	11	1	2	2	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12.00	24.00	24.00																			12.00	24.00	24.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	002	0	1	04	01	H6328_002_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7		Y	Preferred Brand	4	11	1	2	3	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	002	0	1	04	01	H6328_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90.00	180.00	180.00																			90.00	180.00	180.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7		Y	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1815.20	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7		Y	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5.00	10.00	10.00																			5.00	10.00	10.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7		Y	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5.00	10.00	10.00																			5.00	10.00	10.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6328	003	0	1	04	01	H6328_003_0	7		Y	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7		Y	Generic	4	11	1	2	2	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	003	0	1	04	01	H6328_003_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	47.00	94.00	94.00																			47.00	94.00	94.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7		Y	Preferred Brand	4	11	1	2	3	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	47.00	94.00	94.00																			47.00	94.00	94.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6328	003	0	1	04	01	H6328_003_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	100.00	200.00	200.00																			100.00	200.00	200.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	7		Y	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1586.85	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6348	001	0	1	04	01	H6348_001_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	001	0	1	04	01	H6348_001_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	001	0	1	04	01	H6348_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	001	0	1	04	01	H6348_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	001	0	1	04	01	H6348_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	001	0	1	04	01	H6348_001_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6348	002	0	1	04	01	H6348_002_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6351	003	0	1	01	01	H6351_003_0	6		N	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	003	0	1	01	01	H6351_003_0	6		N	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	003	0	1	01	01	H6351_003_0	6		N	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	003	0	1	01	01	H6351_003_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6351	003	0	1	01	01	H6351_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6379	001	0	1	01	01	H6379_001_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		0.00					2.00		0.00											9.00		0.00				2.00		0.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6379	001	0	1	01	01	H6379_001_0	5		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6379	001	0	1	01	01	H6379_001_0	5		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6379	001	0	1	01	01	H6379_001_0	5		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6379	001	0	1	01	01	H6379_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												31		31					31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	001	0	1	01	01	H6396_001_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	001	0	1	01	01	H6396_001_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	001	0	1	01	01	H6396_001_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	001	0	1	01	01	H6396_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	001	0	1	01	01	H6396_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	001	0	1	01	01	H6396_001_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	004	0	1	01	01	H6396_004_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	004	0	1	01	01	H6396_004_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	004	0	1	01	01	H6396_004_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	004	0	1	01	01	H6396_004_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	004	0	1	01	01	H6396_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	004	0	1	01	01	H6396_004_0	4		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	005	0	1	01	01	H6396_005_0	4		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.68	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	005	0	1	01	01	H6396_005_0	4		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.59	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	005	0	1	01	01	H6396_005_0	4		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				86.79	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	005	0	1	01	01	H6396_005_0	4		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.28	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	005	0	1	01	01	H6396_005_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				445.40	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	005	0	1	01	01	H6396_005_0	4		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	011	0	1	01	01	H6396_011_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	011	0	1	01	01	H6396_011_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	011	0	1	01	01	H6396_011_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	011	0	1	01	01	H6396_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	011	0	1	01	01	H6396_011_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	011	0	1	01	01	H6396_011_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	012	0	1	01	01	H6396_012_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	012	0	1	01	01	H6396_012_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	012	0	1	01	01	H6396_012_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	012	0	1	01	01	H6396_012_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	012	0	1	01	01	H6396_012_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	012	0	1	01	01	H6396_012_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	013	0	1	01	01	H6396_013_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	013	0	1	01	01	H6396_013_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	013	0	1	01	01	H6396_013_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	013	0	1	01	01	H6396_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	013	0	1	01	01	H6396_013_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	013	0	1	01	01	H6396_013_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	014	0	1	01	01	H6396_014_0	3		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.68	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	014	0	1	01	01	H6396_014_0	3		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.59	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	014	0	1	01	01	H6396_014_0	3		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				86.79	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	014	0	1	01	01	H6396_014_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.28	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	014	0	1	01	01	H6396_014_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				445.03	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	014	0	1	01	01	H6396_014_0	3		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	015	0	1	01	01	H6396_015_0	4		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.68	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	015	0	1	01	01	H6396_015_0	4		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.59	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	015	0	1	01	01	H6396_015_0	4		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				86.79	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	015	0	1	01	01	H6396_015_0	4		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.28	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	015	0	1	01	01	H6396_015_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				445.40	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6396	015	0	1	01	01	H6396_015_0	4		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6399	001	0	1	01	01	H6399_001_0	5		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H6399	001	0	1	01	01	H6399_001_0	5		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H6399	001	0	1	01	01	H6399_001_0	5		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H6399	001	0	1	01	01	H6399_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H6399	001	0	1	01	01	H6399_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				451.56	29																				29																		29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H6439	002	0	1	01	01	H6439_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	002	0	1	01	01	H6439_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	002	0	1	01	01	H6439_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	002	0	1	01	01	H6439_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	002	0	1	01	01	H6439_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	003	0	1	01	01	H6439_003_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	003	0	1	01	01	H6439_003_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	003	0	1	01	01	H6439_003_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	003	0	1	01	01	H6439_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.91	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	003	0	1	01	01	H6439_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	004	0	1	01	01	H6439_004_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	004	0	1	01	01	H6439_004_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	004	0	1	01	01	H6439_004_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	004	0	1	01	01	H6439_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6439	004	0	1	01	01	H6439_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	001	0	1	01	01	H6446_001_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6446	001	0	1	01	01	H6446_001_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6446	001	0	1	01	01	H6446_001_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	001	0	1	01	01	H6446_001_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6446	003	0	1	01	01	H6446_003_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	003	0	1	01	01	H6446_003_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	004	0	1	01	01	H6446_004_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	005	0	1	01	01	H6446_005_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6446	009	0	1	01	01	H6446_009_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6446	009	0	1	01	01	H6446_009_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	009	0	1	01	01	H6446_009_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6446	010	0	1	01	01	H6446_010_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6446	010	0	1	01	01	H6446_010_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6446	010	0	1	01	01	H6446_010_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6446	011	0	1	01	01	H6446_011_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	011	0	1	01	01	H6446_011_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	011	0	1	01	01	H6446_011_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	011	0	1	01	01	H6446_011_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	011	0	1	01	01	H6446_011_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	012	0	1	01	01	H6446_012_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	012	0	1	01	01	H6446_012_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	012	0	1	01	01	H6446_012_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	012	0	1	01	01	H6446_012_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	012	0	1	01	01	H6446_012_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	013	0	1	01	01	H6446_013_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	013	0	1	01	01	H6446_013_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	013	0	1	01	01	H6446_013_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	013	0	1	01	01	H6446_013_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				88.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	013	0	1	01	01	H6446_013_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	014	0	1	01	01	H6446_014_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	014	0	1	01	01	H6446_014_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	014	0	1	01	01	H6446_014_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	014	0	1	01	01	H6446_014_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	014	0	1	01	01	H6446_014_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	015	0	1	01	01	H6446_015_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	015	0	1	01	01	H6446_015_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	015	0	1	01	01	H6446_015_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	015	0	1	01	01	H6446_015_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	015	0	1	01	01	H6446_015_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	016	0	1	01	01	H6446_016_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	016	0	1	01	01	H6446_016_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	016	0	1	01	01	H6446_016_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	016	0	1	01	01	H6446_016_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				99.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6446	016	0	1	01	01	H6446_016_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	005	0	1	01	01	H6453_005_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_0	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	005	0	1	01	01	H6453_005_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	005	0	1	01	01	H6453_005_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	006	0	1	01	01	H6453_006_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_0	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	006	0	1	01	01	H6453_006_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	006	0	1	01	01	H6453_006_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	1	1	01	01	H6453_007_1	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	1	1	01	01	H6453_007_1	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	007	1	1	01	01	H6453_007_1	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	1	1	01	01	H6453_007_1	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	007	1	1	01	01	H6453_007_1	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	1	1	01	01	H6453_007_1	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	1	1	01	01	H6453_007_1	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	2	1	01	01	H6453_007_2	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	2	1	01	01	H6453_007_2	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	007	2	1	01	01	H6453_007_2	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	2	1	01	01	H6453_007_2	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	007	2	1	01	01	H6453_007_2	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	2	1	01	01	H6453_007_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	007	2	1	01	01	H6453_007_2	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	1	1	01	01	H6453_008_1	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	1	1	01	01	H6453_008_1	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	008	1	1	01	01	H6453_008_1	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	1	1	01	01	H6453_008_1	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	008	1	1	01	01	H6453_008_1	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	1	1	01	01	H6453_008_1	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	1	1	01	01	H6453_008_1	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	2	1	01	01	H6453_008_2	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	2	1	01	01	H6453_008_2	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	008	2	1	01	01	H6453_008_2	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	2	1	01	01	H6453_008_2	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	008	2	1	01	01	H6453_008_2	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	2	1	01	01	H6453_008_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	008	2	1	01	01	H6453_008_2	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	1	1	01	01	H6453_009_1	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	1	1	01	01	H6453_009_1	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	009	1	1	01	01	H6453_009_1	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	1	1	01	01	H6453_009_1	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	009	1	1	01	01	H6453_009_1	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	1	1	01	01	H6453_009_1	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	1	1	01	01	H6453_009_1	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	2	1	01	01	H6453_009_2	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	2	1	01	01	H6453_009_2	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	009	2	1	01	01	H6453_009_2	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	2	1	01	01	H6453_009_2	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	009	2	1	01	01	H6453_009_2	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	2	1	01	01	H6453_009_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	009	2	1	01	01	H6453_009_2	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	1	1	01	01	H6453_010_1	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	1	1	01	01	H6453_010_1	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	010	1	1	01	01	H6453_010_1	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	1	1	01	01	H6453_010_1	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	010	1	1	01	01	H6453_010_1	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	1	1	01	01	H6453_010_1	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	1	1	01	01	H6453_010_1	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	2	1	01	01	H6453_010_2	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	2	1	01	01	H6453_010_2	4		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	0.00											10.00	20.00	30.00				3.00	6.00	0.00				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	010	2	1	01	01	H6453_010_2	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	2	1	01	01	H6453_010_2	4		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					12.00	24.00	36.00											18.00	36.00	54.00				12.00	24.00	36.00				18.00				12.00			0.60	0.40		0.60	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	010	2	1	01	01	H6453_010_2	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	2	1	01	01	H6453_010_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	010	2	1	01	01	H6453_010_2	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											723.78	33						473.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_0	10		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_0	10		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6502	001	0	1	04	01	H6502_001_0	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_0	10		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6502	001	0	1	04	01	H6502_001_0	10		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_0	10		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	001	0	1	04	01	H6502_001_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	11		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	0.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	11		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	0.00																			10.00	20.00	0.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	11		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	11		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6502	002	0	1	04	01	H6502_002_0	11		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	01	01	H6526_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	01	01	H6526_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	01	01	H6526_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6526	001	0	1	01	01	H6526_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	01	01	H6526_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	001	0	1	01	01	H6526_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				388.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6526	002	0	1	01	01	H6526_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6526	002	0	1	01	01	H6526_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				502.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		8.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6528	006	0	1	04	01	H6528_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				146.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	031	0	1	04	01	H6528_031_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	031	0	1	04	01	H6528_031_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	031	0	1	04	01	H6528_031_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6528	031	0	1	04	01	H6528_031_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	031	0	1	04	01	H6528_031_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	031	0	1	04	01	H6528_031_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				463.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	032	0	1	04	01	H6528_032_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	032	0	1	04	01	H6528_032_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	032	0	1	04	01	H6528_032_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6528	032	0	1	04	01	H6528_032_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	032	0	1	04	01	H6528_032_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	032	0	1	04	01	H6528_032_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				463.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6528	033	0	1	04	01	H6528_033_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	033	0	1	04	01	H6528_033_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				454.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	1	1	01	01	H6529_001_1	5		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					2.00	4.00	0.00																	5.00			5.00			0.17	0.00	0.07			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	1	1	01	01	H6529_001_1	5		N	Generic	4	11	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	21.00					8.00	16.00	0.00																	12.00			12.00			0.40	0.23	0.27			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	1	1	01	01	H6529_001_1	5		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	1	1	01	01	H6529_001_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	1	1	01	01	H6529_001_1	5		N	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31												33							33																								33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	2	1	01	01	H6529_001_2	4		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								5.00	10.00	15.00					0.00	0.00	0.00					2.00	4.00	0.00																	5.00			5.00			0.17	0.00	0.07			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	2	1	01	01	H6529_001_2	4		N	Generic	4	11	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								12.00	24.00	36.00					7.00	14.00	21.00					8.00	16.00	0.00																	12.00			12.00			0.40	0.23	0.27			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	2	1	01	01	H6529_001_2	4		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	2	1	01	01	H6529_001_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6529	001	2	1	01	01	H6529_001_2	4		N	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31												33							33																								33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	003	0	1	01	01	H6550_003_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	33						0.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	003	0	1	01	01	H6550_003_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	004	0	1	01	01	H6550_004_0	4		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	004	0	1	01	01	H6550_004_0	4		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	004	0	1	01	01	H6550_004_0	4		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	004	0	1	01	01	H6550_004_0	4		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				82.00	48	48	48																		48	48	48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	004	0	1	01	01	H6550_004_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	005	0	1	01	01	H6550_005_0	2		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	005	0	1	01	01	H6550_005_0	2		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	005	0	1	01	01	H6550_005_0	2		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	005	0	1	01	01	H6550_005_0	2		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				98.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	005	0	1	01	01	H6550_005_0	2		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	006	0	1	01	01	H6550_006_0	3		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	006	0	1	01	01	H6550_006_0	3		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	36.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	006	0	1	01	01	H6550_006_0	3		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	006	0	1	01	01	H6550_006_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				82.00	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	006	0	1	01	01	H6550_006_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6550	007	0	1	01	01	H6550_007_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	25						0.00	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6550	007	0	1	01	01	H6550_007_0	4		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6594	001	0	1	04	01	H6594_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	001	0	1	04	01	H6594_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	001	0	1	04	01	H6594_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	001	0	1	04	01	H6594_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.92	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	001	0	1	04	01	H6594_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	002	0	1	04	01	H6594_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	002	0	1	04	01	H6594_002_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H6594	002	0	1	04	01	H6594_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	002	0	1	04	01	H6594_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	002	0	1	04	01	H6594_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	002	0	1	04	01	H6594_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	003	0	1	04	01	H6594_003_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	003	0	1	04	01	H6594_003_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	003	0	1	04	01	H6594_003_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	003	0	1	04	01	H6594_003_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				83.86	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6594	003	0	1	04	01	H6594_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		0.00				4.00				4.00			0.13	0.07		0.13	0.07	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	017	0	1	01	01	H6622_017_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	2		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					7.00		21.00											11.00		33.00				7.00		0.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	018	0	1	01	01	H6622_018_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0		0.27	0	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	023	0	1	01	01	H6622_023_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	025	0	1	02	01	H6622_025_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	01	01	H6622_026_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	01	01	H6622_026_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	01	01	H6622_026_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	01	01	H6622_026_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	026	0	1	01	01	H6622_026_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		0.00				5.00				5.00			0.17	0.07		0.17	0.07	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	027	0	1	01	01	H6622_027_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	028	0	1	01	01	H6622_028_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	2		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H6622	029	0	1	01	01	H6622_029_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	2		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	2		Y	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	2		Y	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	029	0	1	01	01	H6622_029_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	029	0	1	01	01	H6622_029_0	2		Y	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												15							15												15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	2		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H6622	030	0	1	01	01	H6622_030_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	2		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					2.00		6.00											20.00		60.00				2.00		0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	2		Y	Preferred Brand	4	11	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		110.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	2		Y	Non-Preferred Drug	4	11	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		230.00				100.00				100.00			3.33	2.67		3.33	2.67	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	030	0	1	01	01	H6622_030_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	030	0	1	01	01	H6622_030_0	2		Y	Specialty Tier	4	11	1	1	5	3		010	01		010	1				30								30			30		31												15							15												15						15					15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	032	0	1	01	01	H6622_032_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	032	0	1	01	01	H6622_032_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	033	0	1	01	01	H6622_033_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	034	0	1	01	01	H6622_034_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	035	0	1	01	01	H6622_035_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	036	0	1	01	01	H6622_036_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	037	0	1	01	01	H6622_037_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	038	0	1	01	01	H6622_038_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					1.00		3.00											8.00		24.00				1.00		0.00				8.00				8.00			0.27	0.03		0.27	0.03	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	038	0	1	01	01	H6622_038_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	038	0	1	01	01	H6622_038_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	038	0	1	01	01	H6622_038_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	038	0	1	01	01	H6622_038_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	040	0	1	01	01	H6622_040_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	040	0	1	01	01	H6622_040_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	040	0	1	01	01	H6622_040_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	040	0	1	01	01	H6622_040_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	040	0	1	01	01	H6622_040_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	041	0	1	01	01	H6622_041_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	041	0	1	01	01	H6622_041_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	041	0	1	01	01	H6622_041_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	041	0	1	01	01	H6622_041_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	041	0	1	01	01	H6622_041_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					90.00		270.00											100.00		300.00				90.00		260.00				100.00				100.00			3.33	3		3.33	3	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	047	0	1	01	01	H6622_047_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_048_0	4		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_048_0	4		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_048_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_048_0	4		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	048	0	1	01	01	H6622_048_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	049	0	1	01	01	H6622_049_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					3.00		9.00											19.00		57.00				3.00		0.00				19.00				19.00			0.63	0.10		0.63	0.10	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	051	0	1	01	01	H6622_051_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	052	0	1	01	01	H6622_052_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	054	0	1	01	01	H6622_054_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	055	0	1	01	01	H6622_055_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					0.00		0.00											20.00		60.00				0.00		0.00				20.00				20.00			0.67	0		0.67	0	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	056	0	1	01	01	H6622_056_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	057	0	1	01	01	H6622_057_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	059	0	1	01	01	H6622_059_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	060	0	1	01	01	H6622_060_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	01	01	H6622_061_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	01	01	H6622_061_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	01	01	H6622_061_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	01	01	H6622_061_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	061	0	1	01	01	H6622_061_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					6.00		18.00											20.00		60.00				6.00		0.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	062	0	1	02	01	H6622_062_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	063	0	1	01	01	H6622_063_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	064	0	1	01	01	H6622_064_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	064	0	1	01	01	H6622_064_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	064	0	1	01	01	H6622_064_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	064	0	1	01	01	H6622_064_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	064	0	1	01	01	H6622_064_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	066	0	1	01	01	H6622_066_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	069	0	1	01	01	H6622_069_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	070	0	1	01	01	H6622_070_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	071	0	1	01	01	H6622_071_0	4		Y	Select Care Drugs	4	11	1	2	6	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	072	0	1	01	01	H6622_072_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	072	0	1	01	01	H6622_072_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	072	0	1	01	01	H6622_072_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	072	0	1	01	01	H6622_072_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	072	0	1	01	01	H6622_072_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	073	0	1	02	01	H6622_073_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	9		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																0.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	9		Y	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		37.50					15.00		37.50																15.00				15.00			0.67	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	9		Y	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																42.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																95.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	003	0	1	01	01	H6672_003_0	9		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	2	2	30		90				30		31											1500.00	28		28				1500.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	8		Y	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	2	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																0.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	8		Y	Generic	4	11	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								17.00		42.50					12.00		30.00					12.00		30.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	2	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	2	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	2	2	30		90				30		31											1500.00	33		33				1500.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	8		Y	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	2	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																0.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	8		Y	Generic	4	11	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								17.00		42.50					12.00		30.00					12.00		30.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	2	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	2	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6672	005	0	1	01	01	H6672_005_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	2	2	30		90				30		31											1500.00	33		33				1500.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	01	01	H6706_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	01	01	H6706_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	01	01	H6706_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H6706	001	0	1	01	01	H6706_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	01	01	H6706_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6706	001	0	1	01	01	H6706_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				483.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	001	0	1	04	01	H6713_001_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	001	0	1	04	01	H6713_001_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6713	001	0	1	04	01	H6713_001_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	001	0	1	04	01	H6713_001_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	001	0	1	04	01	H6713_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	001	0	1	04	01	H6713_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	002	0	1	04	01	H6713_002_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	002	0	1	04	01	H6713_002_0	5		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H6713	002	0	1	04	01	H6713_002_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	002	0	1	04	01	H6713_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	002	0	1	04	01	H6713_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6713	002	0	1	04	01	H6713_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											66.51	50		50				75.72	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	11		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	11		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	11		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	11		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	11		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	11		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											66.51	50		50				75.72	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	11		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	3	1	01	01	H6723_001_3	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	3	1	01	01	H6723_001_3	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											66.51	50		50				75.72	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	3	1	01	01	H6723_001_3	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	1	1	01	01	H6723_002_1	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	1	1	01	01	H6723_002_1	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											72.78	50		50				70.87	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	2	1	01	01	H6723_002_2	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	2	1	01	01	H6723_002_2	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											72.78	50		50				70.87	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	3	1	01	01	H6723_002_3	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	3	1	01	01	H6723_002_3	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	3	1	01	01	H6723_002_3	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	3	1	01	01	H6723_002_3	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	3	1	01	01	H6723_002_3	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	3	1	01	01	H6723_002_3	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											72.78	50		50				70.87	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	3	1	01	01	H6723_002_3	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	1	1	01	01	H6723_003_1	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	1	1	01	01	H6723_003_1	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											70.95	50		50				74.87	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	1	1	01	01	H6723_003_1	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	2	1	01	01	H6723_003_2	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	2	1	01	01	H6723_003_2	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											70.95	50		50				74.87	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	2	1	01	01	H6723_003_2	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	3	1	01	01	H6723_003_3	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	3	1	01	01	H6723_003_3	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								6.00		12.00					0.00		0.00					0.00		0.00																6.00				6.00			0.20	0.00	0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	3	1	01	01	H6723_003_3	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	3	1	01	01	H6723_003_3	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		38.00					10.00		25.00					9.00		22.00																15.00				15.00			0.50	0.33	0.30			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	003	3	1	01	01	H6723_003_3	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	3	1	01	01	H6723_003_3	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											70.95	50		50				74.87	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	003	3	1	01	01	H6723_003_3	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	1	1	01	01	H6723_005_1	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	1	1	01	01	H6723_005_1	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	005	1	1	01	01	H6723_005_1	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	1	1	01	01	H6723_005_1	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	005	1	1	01	01	H6723_005_1	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	1	1	01	01	H6723_005_1	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											84.89	50		50				81.14	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	1	1	01	01	H6723_005_1	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	2	1	01	01	H6723_005_2	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	2	1	01	01	H6723_005_2	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		16.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	005	2	1	01	01	H6723_005_2	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	2	1	01	01	H6723_005_2	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	005	2	1	01	01	H6723_005_2	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	2	1	01	01	H6723_005_2	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											84.89	50		50				81.14	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	005	2	1	01	01	H6723_005_2	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	006	1	1	01	01	H6723_006_1	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								12.00		30.00					4.00		10.00					3.00		7.00																12.00				12.00			0.40	0.13	0.10			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								12.00		30.00					4.00		10.00					3.00		7.00																12.00				12.00			0.40	0.13	0.10			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	1	1	01	01	H6723_006_1	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	1	1	01	01	H6723_006_1	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											77.30	50		50				80.17	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	10		N	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		20.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	1	1	01	01	H6723_006_1	10		N	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		20.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	2	1	01	01	H6723_006_2	10		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								12.00		30.00					4.00		10.00					3.00		7.00																12.00				12.00			0.40	0.13	0.10			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	10		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								12.00		30.00					4.00		10.00					3.00		7.00																12.00				12.00			0.40	0.13	0.10			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	2	1	01	01	H6723_006_2	10		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	10		N	Generic	4	01	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		38.00					14.00		35.00																20.00				20.00			0.67	0.50	0.47			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6723	006	2	1	01	01	H6723_006_2	10		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		132.00					42.00		118.00					40.00		110.00																47.00				47.00			1.57	1.40	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	10		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											77.30	50		50				80.17	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	10		N	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								8.00		20.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6723	006	2	1	01	01	H6723_006_2	10		N	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								8.00		20.00					0.00		0.00					0.00		0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H6743	001	0	1	04	01	H6743_001_0	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		190.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	3		N	Specialty Tier	4	10	1	1	5	1	010		01			1	30														30		31				1054.19	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	3		N	Select Care Drugs	4	10	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	3		N	Non-Preferred Drug	4	10	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		190.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1139.48	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		190.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	1	1	04	01	H6743_018_1	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		190.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1270.96	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	018	3	1	04	01	H6743_018_3	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	1	1	04	01	H6743_020_1	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	1	1	04	01	H6743_020_1	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	1	1	04	01	H6743_020_1	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	1	1	04	01	H6743_020_1	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	1	1	04	01	H6743_020_1	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				810.48	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	1	1	04	01	H6743_020_1	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	2	1	04	01	H6743_020_2	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	2	1	04	01	H6743_020_2	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	2	1	04	01	H6743_020_2	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	2	1	04	01	H6743_020_2	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	2	1	04	01	H6743_020_2	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				810.48	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	2	1	04	01	H6743_020_2	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	3	1	04	01	H6743_020_3	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	3	1	04	01	H6743_020_3	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	3	1	04	01	H6743_020_3	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	3	1	04	01	H6743_020_3	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	3	1	04	01	H6743_020_3	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				810.48	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	3	1	04	01	H6743_020_3	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	4	1	04	01	H6743_020_4	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	4	1	04	01	H6743_020_4	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	4	1	04	01	H6743_020_4	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	4	1	04	01	H6743_020_4	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	4	1	04	01	H6743_020_4	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				810.48	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	020	4	1	04	01	H6743_020_4	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	2	1	04	01	H6743_021_2	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	2	1	04	01	H6743_021_2	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	2	1	04	01	H6743_021_2	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	2	1	04	01	H6743_021_2	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		150.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	2	1	04	01	H6743_021_2	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				798.23	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	2	1	04	01	H6743_021_2	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	4	1	04	01	H6743_021_4	4		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	4	1	04	01	H6743_021_4	4		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	4	1	04	01	H6743_021_4	4		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	4	1	04	01	H6743_021_4	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		150.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	4	1	04	01	H6743_021_4	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				798.23	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6743	021	4	1	04	01	H6743_021_4	4		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6750	005	0	1	01	01	H6750_005_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	005	0	1	01	01	H6750_005_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	005	0	1	01	01	H6750_005_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	005	0	1	01	01	H6750_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	005	0	1	01	01	H6750_005_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	005	0	1	01	01	H6750_005_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1495.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	006	0	1	01	01	H6750_006_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	006	0	1	01	01	H6750_006_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	006	0	1	01	01	H6750_006_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	006	0	1	01	01	H6750_006_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	006	0	1	01	01	H6750_006_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	006	0	1	01	01	H6750_006_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1495.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	007	0	1	01	01	H6750_007_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	007	0	1	01	01	H6750_007_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	007	0	1	01	01	H6750_007_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	007	0	1	01	01	H6750_007_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	007	0	1	01	01	H6750_007_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	007	0	1	01	01	H6750_007_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1555.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	008	0	1	01	01	H6750_008_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	008	0	1	01	01	H6750_008_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	008	0	1	01	01	H6750_008_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	008	0	1	01	01	H6750_008_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	008	0	1	01	01	H6750_008_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	008	0	1	01	01	H6750_008_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1975.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	009	0	1	01	01	H6750_009_0	5		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	009	0	1	01	01	H6750_009_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1495.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	1	1	01	01	H6750_012_1	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	1	1	01	01	H6750_012_1	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	012	1	1	01	01	H6750_012_1	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	1	1	01	01	H6750_012_1	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	1	1	01	01	H6750_012_1	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	1	1	01	01	H6750_012_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1675.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	2	1	01	01	H6750_012_2	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	2	1	01	01	H6750_012_2	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	012	2	1	01	01	H6750_012_2	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	2	1	01	01	H6750_012_2	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	2	1	01	01	H6750_012_2	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	012	2	1	01	01	H6750_012_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1675.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	013	0	1	01	01	H6750_013_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	013	0	1	01	01	H6750_013_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	013	0	1	01	01	H6750_013_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	013	0	1	01	01	H6750_013_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	013	0	1	01	01	H6750_013_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	013	0	1	01	01	H6750_013_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1675.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	014	0	1	02	01	H6750_014_0	4		Y	Preferred Generic	4	11	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	014	0	1	02	01	H6750_014_0	4		Y	Preferred Generic	4	11	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	014	0	1	02	01	H6750_014_0	4		Y	Generic	4	11	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	014	0	1	02	01	H6750_014_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	014	0	1	02	01	H6750_014_0	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	014	0	1	02	01	H6750_014_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1675.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6815	005	0	1	01	01	H6815_005_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	30						0.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	005	0	1	01	01	H6815_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	30						0.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	006	0	1	01	01	H6815_006_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	037	0	1	01	01	H6815_037_0	3		N	Preferred Generic	4	01	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6815	037	0	1	01	01	H6815_037_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6815	037	0	1	01	01	H6815_037_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6815	037	0	1	01	01	H6815_037_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6815	037	0	1	01	01	H6815_037_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6815	038	0	1	01	01	H6815_038_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	16.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	225.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											0.00	30						0.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6815	038	0	1	01	01	H6815_038_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6830	001	0	1	04	01	H6830_001_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6832	002	0	1	01	01	H6832_002_0	4		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2.00	4.00	6.00																																						2.00			2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	4		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6832	002	0	1	01	01	H6832_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				856.85	25																																						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6870	001	0	1	48	05	H6870_001_0	7			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6870	001	0	1	48	05	H6870_001_0	7			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6870	001	0	1	48	05	H6870_001_0	7			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6874	001	0	1	04	01	H6874_001_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		6.00					8.00			8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	001	0	1	04	01	H6874_001_0	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								18.00		54.00					12.00		36.00											18.00		54.00				12.00		24.00					18.00			18.00			0.60	0.40		0.60	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	001	0	1	04	01	H6874_001_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		80.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	001	0	1	04	01	H6874_001_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											50.00	50		50				45.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	001	0	1	04	01	H6874_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1716.00	27		27				1716.00	27		27										27		27				27		27				27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		4.00					7.00			7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	5		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								16.00		48.00					10.00		30.00											16.00		48.00				10.00		20.00					16.00			16.00			0.53	0.33		0.53	0.33	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		80.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											58.00	50		50				52.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6874	002	0	1	04	01	H6874_002_0	5		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1653.00	27		27				1653.00	27		27										27		27				27		27				27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	001	0	1	04	01	H6898_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00					0.00	4.00	0.00																8.00				0.00			0.27	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	001	0	1	04	01	H6898_001_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	36.00	52.00					10.00	16.00	22.00					8.00	16.00	16.00																20.00				10.00			0.67	0.33	0.27			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	001	0	1	04	01	H6898_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	74.00	139.00					45.00	47.00	109.00					45.00	74.00	111.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	001	0	1	04	01	H6898_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	194.00	290.00					100.00	194.00	290.00					100.00	194.00	290.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	001	0	1	04	01	H6898_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											37.00	28						37.00	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	002	0	1	04	01	H6898_002_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					0.00	0.00	0.00					0.00	4.00	0.00																6.00				0.00			0.20	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	002	0	1	04	01	H6898_002_0	8		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	24.00	42.00					8.00	12.00	14.00					8.00	16.00	16.00																14.00				8.00			0.47	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	002	0	1	04	01	H6898_002_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								36.00	72.00	108.00					35.00	70.00	105.00					37.00	74.00	111.00																36.00				36.00			1.20	1.17	1.23			1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	002	0	1	04	01	H6898_002_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	194.00	290.00					100.00	194.00	290.00					100.00	194.00	290.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6898	002	0	1	04	01	H6898_002_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											37.00	29						37.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6910	001	0	1	01	01	H6910_001_0	5		Y	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					6.00	12.00	18.00					0.00	0.00	0.00																20.00				20.00			0.67	0.20	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					31.00	62.00	93.00					31.00	62.00	62.00																47.00				47.00			1.57	1.03	1.03			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	001	0	1	01	01	H6910_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											670.00	33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	002	0	1	01	01	H6910_002_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	002	0	1	01	01	H6910_002_0	5		Y	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6910	002	0	1	01	01	H6910_002_0	5		Y	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					6.00	12.00	18.00					0.00	0.00	0.00																20.00				20.00			0.67	0.20	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	002	0	1	01	01	H6910_002_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					31.00	62.00	93.00					31.00	62.00	62.00																47.00				47.00			1.57	1.03	1.03			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	002	0	1	01	01	H6910_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	002	0	1	01	01	H6910_002_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											670.00	33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6910	003	0	1	01	01	H6910_003_0	5		Y	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					6.00	12.00	18.00					0.00	0.00	0.00																20.00				20.00			0.67	0.20	0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					31.00	62.00	93.00					31.00	62.00	62.00																47.00				47.00			1.57	1.03	1.03			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6910	003	0	1	01	01	H6910_003_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											670.00	33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6936	003	0	1	01	01	H6936_003_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	003	0	1	01	01	H6936_003_0	10		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	7.00	7.00	7.00																					7.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	003	0	1	01	01	H6936_003_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	003	0	1	01	01	H6936_003_0	10		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	003	0	1	01	01	H6936_003_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	004	0	1	01	01	H6936_004_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	004	0	1	01	01	H6936_004_0	10		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	7.00	7.00	7.00																					7.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	004	0	1	01	01	H6936_004_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	004	0	1	01	01	H6936_004_0	10		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	004	0	1	01	01	H6936_004_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	005	0	1	01	01	H6936_005_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	005	0	1	01	01	H6936_005_0	10		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	7.00	7.00	7.00																					7.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	005	0	1	01	01	H6936_005_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	005	0	1	01	01	H6936_005_0	10		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	005	0	1	01	01	H6936_005_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	006	0	1	01	01	H6936_006_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	006	0	1	01	01	H6936_006_0	10		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	7.00	7.00	7.00																					7.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	006	0	1	01	01	H6936_006_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	006	0	1	01	01	H6936_006_0	10		N	Non-Preferred Brand	4	10	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6936	006	0	1	01	01	H6936_006_0	10		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6975	001	0	1	01	01	H6975_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	001	0	1	01	01	H6975_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	001	0	1	01	01	H6975_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	001	0	1	01	01	H6975_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	001	0	1	01	01	H6975_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	002	0	1	01	01	H6975_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	002	0	1	01	01	H6975_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	002	0	1	01	01	H6975_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	002	0	1	01	01	H6975_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.62	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	002	0	1	01	01	H6975_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	003	0	1	01	01	H6975_003_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	003	0	1	01	01	H6975_003_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	003	0	1	01	01	H6975_003_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	003	0	1	01	01	H6975_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.90	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	003	0	1	01	01	H6975_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	004	0	1	01	01	H6975_004_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	004	0	1	01	01	H6975_004_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	004	0	1	01	01	H6975_004_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	004	0	1	01	01	H6975_004_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.62	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	004	0	1	01	01	H6975_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	005	0	1	01	01	H6975_005_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	005	0	1	01	01	H6975_005_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	005	0	1	01	01	H6975_005_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	005	0	1	01	01	H6975_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		198.00				99.00				99.00		3.3				3.3	3.3	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6975	005	0	1	01	01	H6975_005_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		9.00																					0.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	6		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	6		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	6		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		8.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		150.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				672.96	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	3		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	3		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	3		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				757.65	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	3		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7020	004	0	1	01	01	H7020_004_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	20.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	004	0	1	01	01	H7020_004_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											627.97	33						644.45	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	006	0	1	01	01	H7020_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											651.94	33						749.58	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	007	0	1	01	01	H7020_007_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	007	0	1	01	01	H7020_007_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	20.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	007	0	1	01	01	H7020_007_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	007	0	1	01	01	H7020_007_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	007	0	1	01	01	H7020_007_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											816.29	33						723.13	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	20.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	008	0	1	01	01	H7020_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											817.22	33						706.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	001	0	1	04	01	H7063_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	001	0	1	04	01	H7063_001_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	12.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	001	0	1	04	01	H7063_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	001	0	1	04	01	H7063_001_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	001	0	1	04	01	H7063_001_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																45.00				45.00			1.50	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	001	0	1	04	01	H7063_001_0	6		N	Non-Preferred Drug	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	001	0	1	04	01	H7063_001_0	6		N	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	12.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	002	0	1	04	01	H7063_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	6		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	002	0	1	04	01	H7063_002_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																45.00				45.00			1.50	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	6		N	Non-Preferred Drug	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	002	0	1	04	01	H7063_002_0	6		N	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	12.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	006	0	1	04	01	H7063_006_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	006	0	1	04	01	H7063_006_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																45.00				45.00			1.50	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	5		N	Non-Preferred Drug	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	006	0	1	04	01	H7063_006_0	5		N	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	13.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	12.00	16.00					3.00	6.00	9.00					3.00	6.00	9.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	007	0	1	04	01	H7063_007_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	17.00	22.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7063	007	0	1	04	01	H7063_007_0	5		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					45.00	90.00	135.00					45.00	90.00	135.00																45.00				45.00			1.50	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	5		N	Non-Preferred Drug	4	10	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7063	007	0	1	04	01	H7063_007_0	5		N	Specialty Tier	4	10	1	1	5	1		010	01	010		1				30					30						30		31												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7076	011	0	1	01	01	H7076_011_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	011	0	1	01	01	H7076_011_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	011	0	1	01	01	H7076_011_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	011	0	1	01	01	H7076_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	011	0	1	01	01	H7076_011_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	011	0	1	01	01	H7076_011_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	012	0	1	01	01	H7076_012_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	012	0	1	01	01	H7076_012_0	5		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	012	0	1	01	01	H7076_012_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	012	0	1	01	01	H7076_012_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	012	0	1	01	01	H7076_012_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	012	0	1	01	01	H7076_012_0	5		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	013	0	1	01	01	H7076_013_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	013	0	1	01	01	H7076_013_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	013	0	1	01	01	H7076_013_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	013	0	1	01	01	H7076_013_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	013	0	1	01	01	H7076_013_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	013	0	1	01	01	H7076_013_0	4		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	014	0	1	01	01	H7076_014_0	5		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	014	0	1	01	01	H7076_014_0	5		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	014	0	1	01	01	H7076_014_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	014	0	1	01	01	H7076_014_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	014	0	1	01	01	H7076_014_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	014	0	1	01	01	H7076_014_0	5		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	015	0	1	01	01	H7076_015_0	3		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.67	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	015	0	1	01	01	H7076_015_0	3		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.63	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	015	0	1	01	01	H7076_015_0	3		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				86.60	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	015	0	1	01	01	H7076_015_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.82	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	015	0	1	01	01	H7076_015_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				446.55	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	015	0	1	01	01	H7076_015_0	3		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	016	0	1	01	01	H7076_016_0	5		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.67	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	016	0	1	01	01	H7076_016_0	5		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.63	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	016	0	1	01	01	H7076_016_0	5		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				86.60	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	016	0	1	01	01	H7076_016_0	5		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.82	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	016	0	1	01	01	H7076_016_0	5		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				446.49	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7076	016	0	1	01	01	H7076_016_0	5		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	001	0	1	01	01	H7115_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					2.00	4.00	4.00					2.00	0.00	0.00																10.00				10.00			0.33	0.07	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	001	0	1	01	01	H7115_001_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	36.00					5.00	10.00	10.00					5.00	10.00	10.00																18.00				18.00			0.60	0.17	0.17			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	001	0	1	01	01	H7115_001_0	7		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	94.00					39.00	78.00	78.00					39.00	78.00	78.00																47.00				47.00			1.57	1.30	1.30			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	001	0	1	01	01	H7115_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	200.00					92.00	184.00	184.00					92.00	184.00	184.00																100.00				100.00			3.33	3.07	3.07			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	001	0	1	01	01	H7115_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	001	0	1	01	01	H7115_001_0	7		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					0.00	0.00	0.00					0.00	0.00	0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	003	0	1	01	01	H7115_003_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					2.00	4.00	4.00					2.00	0.00	0.00																10.00				10.00			0.33	0.07	0.07			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	003	0	1	01	01	H7115_003_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	36.00					5.00	10.00	10.00					5.00	10.00	10.00																18.00				18.00			0.60	0.17	0.17			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	003	0	1	01	01	H7115_003_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	94.00					39.00	78.00	78.00					39.00	78.00	78.00																47.00				47.00			1.57	1.30	1.30			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	003	0	1	01	01	H7115_003_0	6		N	Non-Preferred Drug	4	11	3	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	200.00					92.00	184.00	184.00					92.00	184.00	184.00																100.00				100.00			3.33	3.07	3.07			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	003	0	1	01	01	H7115_003_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7115	003	0	1	01	01	H7115_003_0	6		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					0.00	0.00	0.00					0.00	0.00	0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7123	001	0	1	01	01	H7123_001_0	8		N	Preferred Generic	2	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		10.00							10.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	8		N	Generic	2	11	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					10.00		20.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	8		N	Preferred Brand	2	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								38.00		114.00					18.00		45.00							45.00																38.00				38.00			1.27	0.60				1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	8		N	Non-Preferred Drug	2	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											61.16	49		49				60.02	49		49						49															49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7123	001	0	1	01	01	H7123_001_0	8		N	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31											535.75	25						503.69	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	001	0	1	01	01	H7149_001_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7149	001	0	1	01	01	H7149_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	001	0	1	01	01	H7149_001_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7149	001	0	1	01	01	H7149_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	001	0	1	01	01	H7149_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	001	0	1	01	01	H7149_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											784.50	33						550.23	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	004	0	1	01	01	H7149_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	004	0	1	01	01	H7149_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7149	004	0	1	01	01	H7149_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	004	0	1	01	01	H7149_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7149	004	0	1	01	01	H7149_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	004	0	1	01	01	H7149_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	004	0	1	01	01	H7149_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											716.33	33						557.84	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	006	0	1	01	01	H7149_006_0	3		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	006	0	1	01	01	H7149_006_0	3		N	Generic	4	01	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	006	0	1	01	01	H7149_006_0	3		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	006	0	1	01	01	H7149_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7149	006	0	1	01	01	H7149_006_0	3		N	Specialty Tier	4	11	1	1	5	1	010		10	010		1	30								30							10	31				479.49	30																				30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7163	002	0	1	02	01	H7163_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		100				1	2				31		100	31		31	7.00		21.00																									7.00		21.00				0.00		0.00				7.00				7.00		0.23				0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	5		Y	Generic	4	01	1	2	2	1	110		01		100	1	31		100				1	2						100	31		31	15.00		45.00																											45.00						45.00				15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		100				1	2						100	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01		100	1	31		100				1	2						100	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	002	0	1	02	01	H7163_002_0	5		Y	Specialty Tier	4	10	1	1	5	1	010		01		010	1	31											31			31		31				1385.47	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	003	0	1	02	01	H7163_003_0	7		N	Preferred Generic	2	01	1	2	1	1	110		01		110	1	31		100				1	2				31		100	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	003	0	1	02	01	H7163_003_0	7		N	Generic	2	01	1	2	2	1	110		01		100	1	31		100				1	2						100	31		31	8.00		24.00																											24.00						24.00				8.00				8.00		0.26						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	003	0	1	02	01	H7163_003_0	7		N	Preferred Brand	2	10	1	1	3	1	110		01		100	1	31		100				1	2						100	31		31				118.32	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	003	0	1	02	01	H7163_003_0	7		N	Non-Preferred Brand	2	10	1	1	4	1	110		01		100	1	31		100				1	2						100	31		31				119.15	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	003	0	1	02	01	H7163_003_0	7		N	Specialty Tier	2	10	1	1	5	1	010		01		010	1	31											31			31		31				1094.68	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		110	1	31		100				1	2				31		100	31		31	5.00		15.00																									5.00		15.00				0.00		0.00				5.00				5.00		0.16				0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	5		Y	Generic	4	01	1	2	2	1	110		01		100	1	31		100				1	2						100	31		31	14.00		42.00																											42.00						42.00				14.00				14.00		0.45						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	5		Y	Preferred Brand	4	10	1	2	3	1	110		01		100	1	31		100				1	2						100	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	110		01		100	1	31		100				1	2						100	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7163	004	0	1	02	01	H7163_004_0	5		Y	Specialty Tier	4	10	1	1	5	1	010		01		010	1	31											31			31		31				1342.74	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7165	001	0	1	01	01	H7165_001_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	92.50																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				76.31	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	001	0	1	01	01	H7165_001_0	7		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7165	002	0	1	01	01	H7165_002_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	92.50																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				77.74	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7165	002	0	1	01	01	H7165_002_0	7		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7172	001	0	1	48	05	H7172_001_0	3			Generic Drugs	4	11			1	1	111		10	111		1	30	60	90				2	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7172	001	0	1	48	05	H7172_001_0	3			Brand Drugs	4	11			2	1	111		10	111		1	30	60	90				2	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7172	001	0	1	48	05	H7172_001_0	3			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H7173	001	0	1	01	01	H7173_001_0	3		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7173	001	0	1	01	01	H7173_001_0	3		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7173	001	0	1	01	01	H7173_001_0	3		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7173	001	0	1	01	01	H7173_001_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				90.00	48	48	48																		48	48	48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7173	001	0	1	01	01	H7173_001_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7173	002	0	1	01	01	H7173_002_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	21.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	45.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7173	007	0	1	01	01	H7173_007_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7175	001	0	1	04	01	H7175_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	001	0	1	04	01	H7175_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	001	0	1	04	01	H7175_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	001	0	1	04	01	H7175_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.11	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	001	0	1	04	01	H7175_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	002	0	1	04	01	H7175_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	002	0	1	04	01	H7175_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	002	0	1	04	01	H7175_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	002	0	1	04	01	H7175_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.02	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	002	0	1	04	01	H7175_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	003	0	1	04	01	H7175_003_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	003	0	1	04	01	H7175_003_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	003	0	1	04	01	H7175_003_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	003	0	1	04	01	H7175_003_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				83.84	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	003	0	1	04	01	H7175_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	004	0	1	04	01	H7175_004_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	004	0	1	04	01	H7175_004_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H7175	004	0	1	04	01	H7175_004_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	004	0	1	04	01	H7175_004_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	004	0	1	04	01	H7175_004_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7175	004	0	1	04	01	H7175_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7220	004	0	1	02	01	H7220_004_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	4		N	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	1	1	01	01	H7220_009_1	4		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	2	1	01	01	H7220_009_2	4		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	3.00	6.00	9.00																			3.00	6.00	0.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	12.00	24.00	36.00																			12.00	24.00	0.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	100				2	2	30	60	100				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	009	3	1	01	01	H7220_009_3	4		Y	Select Care Drugs	4	01	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7245	001	0	1	01	01	H7245_001_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					4.00	8.00	12.00					4.00	8.00	0.00																15.00				15.00			0.50	0.13	0.13			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	24.00	36.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	9		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											70.85	33	33	33				70.85	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	29						1.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	0.00																12.00				12.00			0.40	0.07	0.07			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											68.72	33	33	33				68.72	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	29						1.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					4.00	8.00	12.00					4.00	8.00	0.00																12.00				12.00			0.40	0.13	0.13			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	7		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	24.00	36.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											73.75	33	33	33				73.75	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	29						1.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	0.00																12.00				12.00			0.40	0.07	0.07			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											78.66	33	33	33				78.66	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	005	0	1	01	01	H7245_005_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	29						1.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	006	0	1	01	01	H7245_006_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					4.00	8.00	12.00					4.00	8.00	0.00																15.00				15.00			0.50	0.13	0.13			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	006	0	1	01	01	H7245_006_0	9		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	24.00	36.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	006	0	1	01	01	H7245_006_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	006	0	1	01	01	H7245_006_0	9		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											77.64	33	33	33				77.64	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	006	0	1	01	01	H7245_006_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	29						1.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	008	0	1	01	01	H7245_008_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	0.00																12.00				12.00			0.40	0.07	0.07			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	008	0	1	01	01	H7245_008_0	7		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	20.00	30.00					10.00	20.00	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	008	0	1	01	01	H7245_008_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	120.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	008	0	1	01	01	H7245_008_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											71.58	33	33	33				71.58	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	008	0	1	01	01	H7245_008_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	29						1.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7273	001	0	1	04	01	H7273_001_0	9		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	001	0	1	04	01	H7273_001_0	9		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7273	001	0	1	04	01	H7273_001_0	9		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	12.00		36.00																					24.00																12.00				12.00		0.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	001	0	1	04	01	H7273_001_0	9		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	001	0	1	04	01	H7273_001_0	9		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					300.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	001	0	1	04	01	H7273_001_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	001	0	1	04	01	H7273_001_0	9		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	001	0	1	04	01	H7273_001_0	9		N	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7273	002	0	1	04	01	H7273_002_0	9		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	002	0	1	04	01	H7273_002_0	9		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7273	002	0	1	04	01	H7273_002_0	9		N	Generic	4	01	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	12.00		36.00																					24.00																12.00				12.00		0.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	002	0	1	04	01	H7273_002_0	9		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	002	0	1	04	01	H7273_002_0	9		N	Non-Preferred Brand	4	10	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					300.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	002	0	1	04	01	H7273_002_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	31														31		31					29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	002	0	1	04	01	H7273_002_0	9		N	Select Care Drugs	4	11	1	2	6	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7273	002	0	1	04	01	H7273_002_0	9		N	Select Care Drugs	4	11	1	2	6	3	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7284	001	0	1	04	01	H7284_001_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	001	0	1	04	01	H7284_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	002	0	1	04	01	H7284_002_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	002	0	1	04	01	H7284_002_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	002	0	1	04	01	H7284_002_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	002	0	1	04	01	H7284_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	002	0	1	04	01	H7284_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	5		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7284	003	0	1	04	01	H7284_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	002	0	1	04	01	H7301_002_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	002	0	1	04	01	H7301_002_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	002	0	1	04	01	H7301_002_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	002	0	1	04	01	H7301_002_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	002	0	1	04	01	H7301_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	002	0	1	04	01	H7301_002_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											692.98	33						407.49	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	006	0	1	04	01	H7301_006_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	006	0	1	04	01	H7301_006_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	006	0	1	04	01	H7301_006_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	006	0	1	04	01	H7301_006_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	006	0	1	04	01	H7301_006_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	006	0	1	04	01	H7301_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	006	0	1	04	01	H7301_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											752.64	33						562.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	007	0	1	04	01	H7301_007_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	007	0	1	04	01	H7301_007_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	007	0	1	04	01	H7301_007_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	007	0	1	04	01	H7301_007_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	007	0	1	04	01	H7301_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	007	0	1	04	01	H7301_007_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	007	0	1	04	01	H7301_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											735.75	33						458.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	009	0	1	04	01	H7301_009_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	009	0	1	04	01	H7301_009_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	009	0	1	04	01	H7301_009_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	009	0	1	04	01	H7301_009_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	009	0	1	04	01	H7301_009_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	009	0	1	04	01	H7301_009_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7301	009	0	1	04	01	H7301_009_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											833.22	33						638.10	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H7322	001	0	1	01	01	H7322_001_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	001	0	1	01	01	H7322_001_0	5		N	Generic	4	11	3	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	001	0	1	01	01	H7322_001_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	42.00		126.00																			42.00		126.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	001	0	1	01	01	H7322_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	001	0	1	01	01	H7322_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				860.88	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	002	0	1	01	01	H7322_002_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	002	0	1	01	01	H7322_002_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	002	0	1	01	01	H7322_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	002	0	1	01	01	H7322_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7322	002	0	1	01	01	H7322_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				861.67	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	001	0	1	04	01	H7323_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	001	0	1	04	01	H7323_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	001	0	1	04	01	H7323_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	001	0	1	04	01	H7323_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.13	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	001	0	1	04	01	H7323_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	002	0	1	04	01	H7323_002_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	002	0	1	04	01	H7323_002_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	002	0	1	04	01	H7323_002_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	002	0	1	04	01	H7323_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.15	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	002	0	1	04	01	H7323_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	003	0	1	04	01	H7323_003_0	5		Y	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	003	0	1	04	01	H7323_003_0	5		Y	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7323	003	0	1	04	01	H7323_003_0	5		Y	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	003	0	1	04	01	H7323_003_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	003	0	1	04	01	H7323_003_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.90	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	003	0	1	04	01	H7323_003_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	004	0	1	04	01	H7323_004_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	004	0	1	04	01	H7323_004_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	004	0	1	04	01	H7323_004_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	004	0	1	04	01	H7323_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.18	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	004	0	1	04	01	H7323_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	005	0	1	04	01	H7323_005_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	005	0	1	04	01	H7323_005_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	005	0	1	04	01	H7323_005_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	005	0	1	04	01	H7323_005_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				83.86	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	005	0	1	04	01	H7323_005_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	006	0	1	04	01	H7323_006_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	006	0	1	04	01	H7323_006_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	006	0	1	04	01	H7323_006_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	006	0	1	04	01	H7323_006_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.69	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7323	006	0	1	04	01	H7323_006_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	001	0	1	04	01	H7326_001_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	001	0	1	04	01	H7326_001_0	6		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H7326	001	0	1	04	01	H7326_001_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	001	0	1	04	01	H7326_001_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	001	0	1	04	01	H7326_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	001	0	1	04	01	H7326_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	002	0	1	04	01	H7326_002_0	6		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	002	0	1	04	01	H7326_002_0	6		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	002	0	1	04	01	H7326_002_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	002	0	1	04	01	H7326_002_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				63.99	35		35																								35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	002	0	1	04	01	H7326_002_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	003	0	1	04	01	H7326_003_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	003	0	1	04	01	H7326_003_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H7326	003	0	1	04	01	H7326_003_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	003	0	1	04	01	H7326_003_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	003	0	1	04	01	H7326_003_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	003	0	1	04	01	H7326_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	004	0	1	04	01	H7326_004_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	004	0	1	04	01	H7326_004_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7326	004	0	1	04	01	H7326_004_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.3				0.3	0.3	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	004	0	1	04	01	H7326_004_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	004	0	1	04	01	H7326_004_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7326	004	0	1	04	01	H7326_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7330	001	0	1	01	01	H7330_001_0	10		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	001	0	1	01	01	H7330_001_0	10		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7330	001	0	1	01	01	H7330_001_0	10		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	001	0	1	01	01	H7330_001_0	10		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7330	001	0	1	01	01	H7330_001_0	10		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	001	0	1	01	01	H7330_001_0	10		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	001	0	1	01	01	H7330_001_0	10		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	001	0	1	01	01	H7330_001_0	10		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	001	0	1	01	01	H7330_001_0	10		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7330	002	0	1	02	01	H7330_002_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	002	0	1	02	01	H7330_002_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					7.00	14.00	14.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7330	002	0	1	02	01	H7330_002_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	002	0	1	02	01	H7330_002_0	8		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					15.00	30.00	30.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7330	002	0	1	02	01	H7330_002_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					45.00	90.00	90.00																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	002	0	1	02	01	H7330_002_0	8		N	Non-Preferred Brand	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	200.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	002	0	1	02	01	H7330_002_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	002	0	1	02	01	H7330_002_0	8		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7330	002	0	1	02	01	H7330_002_0	8		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7399	001	0	1	01	01	H7399_001_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	001	0	1	01	01	H7399_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7399	002	0	1	01	01	H7399_002_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7404	001	0	1	04	01	H7404_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	001	0	1	04	01	H7404_001_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	001	0	1	04	01	H7404_001_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	001	0	1	04	01	H7404_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	001	0	1	04	01	H7404_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	001	0	1	04	01	H7404_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				244.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	002	0	1	04	01	H7404_002_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	002	0	1	04	01	H7404_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				248.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	005	0	1	04	01	H7404_005_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	005	0	1	04	01	H7404_005_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				320.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	006	0	1	04	01	H7404_006_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	006	0	1	04	01	H7404_006_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				245.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	011	0	1	04	01	H7404_011_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	011	0	1	04	01	H7404_011_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				229.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	012	0	1	04	01	H7404_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	012	0	1	04	01	H7404_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				268.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	014	0	1	04	01	H7404_014_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	014	0	1	04	01	H7404_014_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				253.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	5		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	5		Y	Preferred Generic	4	01	1	2	1	3	110		01		100	1	30		100				2	2						100	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7404	018	0	1	04	01	H7404_018_0	5		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	5		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	018	0	1	04	01	H7404_018_0	5		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	018	0	1	04	01	H7404_018_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				272.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	2	2						100	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		100	2	2						100	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	020	0	1	04	01	H7404_020_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		100	2	2						100	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		100	2	2						100	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	020	0	1	04	01	H7404_020_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											297.00	29						264.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		100				2	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		100				2	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7404	021	0	1	04	01	H7404_021_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		100				2	2						100	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		100				2	2						100	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7404	021	0	1	04	01	H7404_021_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				332.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7409	001	0	1	01	01	H7409_001_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7409	001	0	1	01	01	H7409_001_0	5		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.34	25		25				7.34	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7409	001	0	1	01	01	H7409_001_0	5		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											104.42	25		25				104.42	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7409	001	0	1	01	01	H7409_001_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											66.10	25		25				66.10	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7409	001	0	1	01	01	H7409_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											592.28	25						592.28	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7409	001	0	1	01	01	H7409_001_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7419	001	0	1	48	05	H7419_001_0	2			$0 Drugs	4	11			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	2			Generic Drugs	4	01			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	2			Brand Drugs	4	10			3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	2			Non-Medicare Rx/OTC Drugs	4	11			4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					$0 Drugs, Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7445	005	0	1	01	01	H7445_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7445	005	0	1	01	01	H7445_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7445	005	0	1	01	01	H7445_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H7445	005	0	1	01	01	H7445_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7445	005	0	1	01	01	H7445_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7445	005	0	1	01	01	H7445_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				415.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	5		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7511	002	0	1	01	01	H7511_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7518	001	0	1	04	01	H7518_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	001	0	1	04	01	H7518_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	001	0	1	04	01	H7518_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	001	0	1	04	01	H7518_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	001	0	1	04	01	H7518_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	003	0	1	04	01	H7518_003_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	003	0	1	04	01	H7518_003_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	003	0	1	04	01	H7518_003_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	003	0	1	04	01	H7518_003_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.09	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7518	003	0	1	04	01	H7518_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7594	001	0	1	01	01	H7594_001_0	15		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	001	0	1	01	01	H7594_001_0	15		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		.40			0.40			.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	001	0	1	01	01	H7594_001_0	15		Y	Preferred Brand	4	11	3	2	3	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	001	0	1	01	01	H7594_001_0	15		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	001	0	1	01	01	H7594_001_0	15		Y	Specialty Tier	4	11	1	1	5	1	011		01	010		1	30	60					2	1	30						30		31				0.00	33	33																			33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	001	0	1	01	01	H7594_001_0	15		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	002	0	1	01	01	H7594_002_0	10		Y	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	002	0	1	01	01	H7594_002_0	10		Y	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	002	0	1	01	01	H7594_002_0	10		Y	Preferred Brand	4	11	3	1	3	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	002	0	1	01	01	H7594_002_0	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	002	0	1	01	01	H7594_002_0	10		Y	Specialty Tier	4	11	1	1	5	1	011		01	010		1	30	60					2	1	30						30		31				0.00	25	25																			25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	002	0	1	01	01	H7594_002_0	10		Y	Select Care Drugs	4	11	1	1	6	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	003	0	1	01	01	H7594_003_0	9		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	003	0	1	01	01	H7594_003_0	9		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31	9.00	18.00	27.00																			9.00	18.00	18.00																9.00				9.00		.30			.30			.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	003	0	1	01	01	H7594_003_0	9		Y	Preferred Brand	4	11	3	2	3	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	003	0	1	01	01	H7594_003_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	270.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	003	0	1	01	01	H7594_003_0	9		Y	Specialty Tier	4	11	1	1	5	1	011		01	010		1	30	60					2	1	30						30		31				0.00	33	33																			33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	003	0	1	01	01	H7594_003_0	9		Y	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	004	0	1	01	01	H7594_004_0	10		Y	Preferred Generic	4	01	1	1	1	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	004	0	1	01	01	H7594_004_0	10		Y	Generic	4	01	1	1	2	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	004	0	1	01	01	H7594_004_0	10		Y	Preferred Brand	4	11	3	1	3	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	004	0	1	01	01	H7594_004_0	10		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	1	30	60	90				30		31				0.00	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	004	0	1	01	01	H7594_004_0	10		Y	Specialty Tier	4	11	1	1	5	1	011		01	010		1	30	60					2	1	30						30		31				0.00	25	25																			25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7594	004	0	1	01	01	H7594_004_0	10		Y	Select Care Drugs	4	11	1	1	6	1	111		01	111		1	30	60	90				1	1	30	60	90				30		31				0.00	0	0	0																		0	0	0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7598	001	0	1	01	01	H7598_001_0	5		N	Preferred Generic	3	01	1	2	1	1	111		01			1	30	60	90				2	2							30		31	0.00	0.00	0.00																																					0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7598	001	0	1	01	01	H7598_001_0	5		N	Generic	3	01	1	2	2	1	111		01			1	30	60	90				2	2							30		31	15.00	30.00	45.00																																					15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7598	001	0	1	01	01	H7598_001_0	5		N	Preferred Brand	3	10	1	2	3	1	111		01			1	30	60	90				2	2							30		31	42.00	84.00	126.00																																					42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7598	001	0	1	01	01	H7598_001_0	5		N	Non-Preferred Drug	3	10	1	1	4	1	111		01			1	30	60	90				2	2							30		31				64.82	45	45	45																																			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7598	001	0	1	01	01	H7598_001_0	5		N	Specialty Tier	3	11	1	1	5	1	111		01			1	30	60	90				2	2							30		31					25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7607	002	1	1	01	01	H7607_002_1	8		Y	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	8		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	1	1	01	01	H7607_002_1	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	8		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	1	1	01	01	H7607_002_1	8		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	8		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	8		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				993.30	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	1	1	01	01	H7607_002_1	8		Y	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	8		Y	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	8		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	2	1	01	01	H7607_002_2	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	8		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	2	1	01	01	H7607_002_2	8		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	8		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	8		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				993.30	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	2	1	01	01	H7607_002_2	8		Y	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	8		Y	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	8		Y	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	3	1	01	01	H7607_002_3	8		Y	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	8		Y	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	002	3	1	01	01	H7607_002_3	8		Y	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	8		Y	Non-Preferred Brand	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	8		Y	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				993.30	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	002	3	1	01	01	H7607_002_3	8		Y	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	1	1	01	01	H7607_003_1	8		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	1	1	01	01	H7607_003_1	8		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	1	1	01	01	H7607_003_1	8		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				13.97	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	1	1	01	01	H7607_003_1	8		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				128.97	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	1	1	01	01	H7607_003_1	8		N	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				79.92	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	1	1	01	01	H7607_003_1	8		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				610.74	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	1	1	01	01	H7607_003_1	8		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	2	1	01	01	H7607_003_2	8		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	2	1	01	01	H7607_003_2	8		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	2	1	01	01	H7607_003_2	8		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				13.97	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	2	1	01	01	H7607_003_2	8		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				128.97	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	2	1	01	01	H7607_003_2	8		N	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				79.92	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	2	1	01	01	H7607_003_2	8		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				610.74	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	2	1	01	01	H7607_003_2	8		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	3	1	01	01	H7607_003_3	8		N	Preferred Generic	4	01	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	3	1	01	01	H7607_003_3	8		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs										1		
H7607	003	3	1	01	01	H7607_003_3	8		N	Generic	4	01	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				13.97	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	3	1	01	01	H7607_003_3	8		N	Preferred Brand	4	10	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				128.97	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	3	1	01	01	H7607_003_3	8		N	Non-Preferred Brand	4	11	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				79.92	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	3	1	01	01	H7607_003_3	8		N	Specialty Tier	4	11	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				610.74	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7607	003	3	1	01	01	H7607_003_3	8		N	Supplemental Drugs	4	11	2	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Drugs												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					11.00		33.00											20.00		60.00				11.00		0.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	001	0	1	01	01	H7621_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	2		Y	Preferred Generic	4	11	3	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7621	002	0	1	01	01	H7621_002_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	2		Y	Generic	4	11	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					5.00		15.00											20.00		60.00				5.00		0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7621	002	0	1	01	01	H7621_002_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	002	0	1	01	01	H7621_002_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	2		Y	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7621	003	0	1	01	01	H7621_003_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	001	0	1	02	01	H7646_001_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	001	0	1	02	01	H7646_001_0	8		N	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	001	0	1	02	01	H7646_001_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	112.50																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	001	0	1	02	01	H7646_001_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	237.50																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	001	0	1	02	01	H7646_001_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											853.93	33						853.93	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	002	0	1	02	01	H7646_002_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	002	0	1	02	01	H7646_002_0	7		N	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	002	0	1	02	01	H7646_002_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	112.50																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	002	0	1	02	01	H7646_002_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	237.50																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	002	0	1	02	01	H7646_002_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											853.93	33						853.93	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		N	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	112.50																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	237.50																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	003	0	1	02	01	H7646_003_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											853.93	33						853.93	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	004	0	1	02	01	H7646_004_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	004	0	1	02	01	H7646_004_0	8		N	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	004	0	1	02	01	H7646_004_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	112.50																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	004	0	1	02	01	H7646_004_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	237.50																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	004	0	1	02	01	H7646_004_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											853.93	33						853.93	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	005	0	1	02	01	H7646_005_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	005	0	1	02	01	H7646_005_0	8		N	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	005	0	1	02	01	H7646_005_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	112.50																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	005	0	1	02	01	H7646_005_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	237.50																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	005	0	1	02	01	H7646_005_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											853.93	33						853.93	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	006	0	1	02	01	H7646_006_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	006	0	1	02	01	H7646_006_0	7		N	Generic	4	11	3	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	006	0	1	02	01	H7646_006_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	112.50																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	006	0	1	02	01	H7646_006_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00	190.00	237.50																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7646	006	0	1	02	01	H7646_006_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											853.93	33						853.93	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7678	001	0	1	01	01	H7678_001_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	5.00	10.00	15.00																			5.00	10.00	15.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.35			1.35			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.53	32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				543.80	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	7		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	7		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7680	001	0	1	01	01	H7680_001_0	7		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	7		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7680	001	0	1	01	01	H7680_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	35.00	70.00	105.00																					105.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	7		Y	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	001	0	1	01	01	H7680_001_0	7		Y	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7680	002	0	1	01	01	H7680_002_0	7		Y	Preferred Generic	4	01	3	2	1	1	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	7		Y	Preferred Generic	4	01	3	2	1	3	111		01	100		1	30	60	100				1	2			100				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7680	002	0	1	01	01	H7680_002_0	7		Y	Generic	4	01	1	2	2	1	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	7		Y	Generic	4	01	1	2	2	3	111		01	100		1	30	60	100				1	2			100				30		31	12.00	24.00	24.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7680	002	0	1	01	01	H7680_002_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	100				1	2			100				30		31	35.00	70.00	105.00																					105.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	100				1	2			100				30		31	100.00	200.00	300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	7		Y	Select Care Drugs	4	01	1	2	6	1	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7680	002	0	1	01	01	H7680_002_0	7		Y	Select Care Drugs	4	01	1	2	6	3	111		10	100		1	30	60	100				1	2			100					29	31	0.00	0.00	0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	002	0	1	04	01	H7728_002_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	82.00	82.00																46.00				46.00			1.53	1.37	1.37			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	004	1	1	04	01	H7728_004_1	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	24.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	1	1	04	01	H7728_004_1	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	004	2	1	04	01	H7728_004_2	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	24.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	004	2	1	04	01	H7728_004_2	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	005	0	1	04	01	H7728_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	005	0	1	04	01	H7728_005_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	006	0	1	04	01	H7728_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	26.00	26.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	006	0	1	04	01	H7728_006_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7728	009	0	1	04	01	H7728_009_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	24.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	009	0	1	04	01	H7728_009_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H7787	001	0	1	04	01	H7787_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7787	001	0	1	04	01	H7787_001_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											720.72	29						555.40	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7833	001	0	1	48	05	H7833_001_0	6			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.70	0.00	3.70	0.00	3.70	0.00	3.70			
H7833	001	0	1	48	05	H7833_001_0	6			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.20	0.00	9.20	0.00	9.20	0.00	9.20			
H7833	001	0	1	48	05	H7833_001_0	6			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	5			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	5			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7844	001	0	1	48	05	H7844_001_0	5			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7849	001	0	1	04	01	H7849_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	001	0	1	04	01	H7849_001_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	001	0	1	04	01	H7849_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	001	0	1	04	01	H7849_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	001	0	1	04	01	H7849_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	24.00					4.00	8.00	8.00											12.00	24.00	24.00				4.00	8.00	8.00				12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.54	48	48	48				75.02	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	002	0	1	04	01	H7849_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											759.15	33						837.32	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	003	0	1	04	01	H7849_003_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	003	0	1	04	01	H7849_003_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					12.00	24.00	30.00											20.00	40.00	60.00				12.00	24.00	0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	003	0	1	04	01	H7849_003_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	003	0	1	04	01	H7849_003_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	003	0	1	04	01	H7849_003_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											722.97	31						606.98	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	006	0	1	04	01	H7849_006_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	006	0	1	04	01	H7849_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											798.00	33						711.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	007	0	1	04	01	H7849_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	007	0	1	04	01	H7849_007_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	007	0	1	04	01	H7849_007_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	007	0	1	04	01	H7849_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	007	0	1	04	01	H7849_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	007	0	1	04	01	H7849_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											798.00	33						711.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	008	0	1	04	01	H7849_008_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	008	0	1	04	01	H7849_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											807.59	33						532.54	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	009	0	1	04	01	H7849_009_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	009	0	1	04	01	H7849_009_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	009	0	1	04	01	H7849_009_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	009	0	1	04	01	H7849_009_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	009	0	1	04	01	H7849_009_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	009	0	1	04	01	H7849_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											807.59	33						532.54	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	010	0	1	04	01	H7849_010_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											802.41	33						684.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	011	0	1	04	01	H7849_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	011	0	1	04	01	H7849_011_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	25.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	011	0	1	04	01	H7849_011_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	011	0	1	04	01	H7849_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	011	0	1	04	01	H7849_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											947.03	33						752.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	012	0	1	04	01	H7849_012_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	5.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	012	0	1	04	01	H7849_012_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	10.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	012	0	1	04	01	H7849_012_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	012	0	1	04	01	H7849_012_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	012	0	1	04	01	H7849_012_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											744.65	33						683.01	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	013	0	1	04	01	H7849_013_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	5.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	013	0	1	04	01	H7849_013_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	10.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	013	0	1	04	01	H7849_013_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	013	0	1	04	01	H7849_013_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	013	0	1	04	01	H7849_013_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											744.65	33						683.01	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	014	0	1	04	01	H7849_014_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	014	0	1	04	01	H7849_014_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7849	014	0	1	04	01	H7849_014_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	014	0	1	04	01	H7849_014_0	6		N	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	014	0	1	04	01	H7849_014_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	014	0	1	04	01	H7849_014_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	014	0	1	04	01	H7849_014_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											680.82	30						573.98	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	015	0	1	04	01	H7849_015_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					5.00	10.00	10.00											20.00	40.00	40.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	015	0	1	04	01	H7849_015_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											855.67	33						711.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	20.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	016	0	1	04	01	H7849_016_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											707.16	31						631.10	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	4.00											7.00	14.00	21.00				2.00	4.00	0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	017	0	1	04	01	H7849_017_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											771.92	33						688.98	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	018	0	1	04	01	H7849_018_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	018	0	1	04	01	H7849_018_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	25.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	018	0	1	04	01	H7849_018_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	018	0	1	04	01	H7849_018_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	018	0	1	04	01	H7849_018_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											817.22	33						706.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	019	0	1	04	01	H7849_019_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	019	0	1	04	01	H7849_019_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	25.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	019	0	1	04	01	H7849_019_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	019	0	1	04	01	H7849_019_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	019	0	1	04	01	H7849_019_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											947.03	33						752.36	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	7.50											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	30.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	020	0	1	04	01	H7849_020_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											658.33	29						552.71	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	7.50											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	30.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	021	0	1	04	01	H7849_021_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											722.97	31						606.98	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	7.50											8.00	16.00	24.00				3.00	6.00	0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	30.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	022	0	1	04	01	H7849_022_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											658.33	29						552.71	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					0.00	0.00	0.00											8.00	16.00	24.00				0.00	0.00	0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								17.00	34.00	51.00					12.00	24.00	30.00											17.00	34.00	51.00				12.00	24.00	0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	023	0	1	04	01	H7849_023_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											722.97	31						606.98	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	024	0	1	04	01	H7849_024_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	024	0	1	04	01	H7849_024_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	024	0	1	04	01	H7849_024_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	024	0	1	04	01	H7849_024_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.90	46	46	46				77.86	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	024	0	1	04	01	H7849_024_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											809.98	33						763.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	026	0	1	04	01	H7849_026_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	027	0	1	04	01	H7849_027_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.17		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	028	0	1	04	01	H7849_028_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				0.00	0.00	0.00				20.00				20.00			0.67	0.17		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	029	0	1	04	01	H7849_029_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											830.15	33						790.67	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	030	0	1	04	01	H7849_030_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	030	0	1	04	01	H7849_030_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											799.04	33						713.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	031	0	1	04	01	H7849_031_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	031	0	1	04	01	H7849_031_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											799.04	33						713.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	032	0	1	04	01	H7849_032_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	032	0	1	04	01	H7849_032_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											799.04	33						713.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	033	0	1	04	01	H7849_033_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	30.00					5.00	10.00	10.00											15.00	30.00	30.00				5.00	10.00	0.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	033	0	1	04	01	H7849_033_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											799.04	33						713.49	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	034	0	1	04	01	H7849_034_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											855.67	33						711.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	035	0	1	04	01	H7849_035_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											848.46	33						701.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	036	0	1	04	01	H7849_036_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	036	0	1	04	01	H7849_036_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	036	0	1	04	01	H7849_036_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	036	0	1	04	01	H7849_036_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	036	0	1	04	01	H7849_036_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											855.67	33						711.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	037	0	1	04	01	H7849_037_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	037	0	1	04	01	H7849_037_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	037	0	1	04	01	H7849_037_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	037	0	1	04	01	H7849_037_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	037	0	1	04	01	H7849_037_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											855.67	33						711.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	038	0	1	04	01	H7849_038_0	7		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	038	0	1	04	01	H7849_038_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											669.72	29						526.51	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	039	0	1	04	01	H7849_039_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	039	0	1	04	01	H7849_039_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											669.72	29						526.51	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	040	0	1	04	01	H7849_040_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	040	0	1	04	01	H7849_040_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											669.72	29						526.51	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	041	0	1	04	01	H7849_041_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	041	0	1	04	01	H7849_041_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											669.72	29						526.51	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7849	042	0	1	04	01	H7849_042_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					4.00	8.00	8.00											20.00	40.00	60.00				4.00	8.00	0.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	042	0	1	04	01	H7849_042_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											669.72	29						526.51	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	12.50					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	22.50					4.00	8.00	10.00											9.00	18.00	22.50				0.00	0.00	0.00				9.00				9.00			0.30	0.13		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00	90.00	135.00				40.00	80.00	120.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								85.00	170.00	255.00					80.00	160.00	240.00											85.00	170.00	255.00				80.00	160.00	240.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7849	043	0	1	04	01	H7849_043_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											876.16	33						623.46	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7853	001	0	1	01	01	H7853_001_0	6		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	001	0	1	01	01	H7853_001_0	6		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	001	0	1	01	01	H7853_001_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	001	0	1	01	01	H7853_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	001	0	1	01	01	H7853_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				811.88	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	001	0	1	01	01	H7853_001_0	6		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	001	0	1	01	01	H7853_001_0	6		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7853	002	0	1	01	01	H7853_002_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	002	0	1	01	01	H7853_002_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		16.00																			8.00		16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	002	0	1	01	01	H7853_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	002	0	1	01	01	H7853_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		200.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	002	0	1	01	01	H7853_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				785.26	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	002	0	1	01	01	H7853_002_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	002	0	1	01	01	H7853_002_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7853	005	0	1	01	01	H7853_005_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	005	0	1	01	01	H7853_005_0	5		N	Generic	4	11	1	1	2	1	110		01	110		1	30		90				1	2	30		90				30		31				7.72	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	005	0	1	01	01	H7853_005_0	5		N	Preferred Brand	4	11	1	1	3	1	110		01	110		1	30		90				1	2	30		90				30		31				109.52	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	005	0	1	01	01	H7853_005_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				62.32	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	005	0	1	01	01	H7853_005_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				571.47	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	005	0	1	01	01	H7853_005_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	005	0	1	01	01	H7853_005_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7853	007	0	1	01	01	H7853_007_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	007	0	1	01	01	H7853_007_0	5		N	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					13.00		39.00					13.00		26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	007	0	1	01	01	H7853_007_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		120.00					40.00		80.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	007	0	1	01	01	H7853_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					93.00		279.00					93.00		186.00																100.00				100.00			3.33	3.1	3.1			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	007	0	1	01	01	H7853_007_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											617.94	25						617.94	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	007	0	1	01	01	H7853_007_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	007	0	1	01	01	H7853_007_0	5		N	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7853	008	0	1	01	01	H7853_008_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	008	0	1	01	01	H7853_008_0	5		N	Generic	4	11	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					13.00		39.00					13.00		26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	008	0	1	01	01	H7853_008_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		120.00					40.00		80.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	008	0	1	01	01	H7853_008_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					93.00		279.00					93.00		186.00																100.00				100.00			3.33	3.1	3.1			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	008	0	1	01	01	H7853_008_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											607.33	25						607.33	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	008	0	1	01	01	H7853_008_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7853	008	0	1	01	01	H7853_008_0	5		N	Select Care Drugs	4	11	3	2	6	3		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H7885	001	0	1	48	05	H7885_001_0	4			Generic Drugs	4	01			1	1	110		01			1	31		93				2	2							31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.70	0.00	3.70			0.00	3.70			
H7885	001	0	1	48	05	H7885_001_0	4			Brand Drugs	4	10			2	1	110		01			1	31		93				2	2							31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.20	0.00	9.20			0.00	9.20			
H7885	001	0	1	48	05	H7885_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01			1	31		93				1	2							31		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	6			Generic Drugs	4	01			1	1	111		01	100		1	31	60	90				2	2			90				31		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	6			Brand Drugs	4	10			2	1	111		01	100		1	31	60	90				2	2			90				31		31																																														0.29						0.29	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	9.20	0.00	9.20	0.00	9.20	0.00	9.20			
H7890	001	0	1	48	05	H7890_001_0	6			Non-Medicare Rx Drugs	4	11			3	1	111		01	100		1	31	60	90				1	2			90				31		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	6			Non-Medicare OTC Drugs	4	11			4	1	111		01	100		1	31	60	90				1	2			90				31		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7917	009	0	1	04	01	H7917_009_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	009	0	1	04	01	H7917_009_0	9		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	145.00					50.00	100.00	125.00											55.00	110.00	145.00				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	010	0	1	04	01	H7917_010_0	8		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	145.00					50.00	100.00	125.00											55.00	110.00	145.00				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	011	0	1	04	01	H7917_011_0	8		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								55.00	110.00	145.00					50.00	100.00	125.00											55.00	110.00	145.00				50.00	100.00	125.00					55.00			55.00			1.83	1.67		1.83	1.67	1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	012	0	1	04	01	H7917_012_0	8		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					70.00			70.00			2.33	2.17		2.33	2.17	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	013	0	1	04	01	H7917_013_0	8		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					70.00			70.00			2.33	2.17		2.33	2.17	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	014	0	1	04	01	H7917_014_0	8		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					70.00			70.00			2.33	2.17		2.33	2.17	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	015	0	1	04	01	H7917_015_0	8		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								33.00	66.00	95.00					28.00	56.00	70.00											33.00	66.00	95.00				28.00	56.00	70.00					33.00			33.00			1.10	0.93		1.10	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								70.00	140.00	185.00					65.00	130.00	165.00											70.00	140.00	185.00				65.00	130.00	165.00					70.00			70.00			2.33	2.17		2.33	2.17	2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	11		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	11		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	030	0	1	04	01	H7917_030_0	11		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	11		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	11		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	031	0	1	04	01	H7917_031_0	11		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	11		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	11		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	032	0	1	04	01	H7917_032_0	11		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	11		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	11		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	033	0	1	04	01	H7917_033_0	11		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								15.00	30.00	35.00					10.00	10.00	10.00											15.00	30.00	35.00				10.00	10.00	10.00					15.00			15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	11		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								47.00	94.00	135.00					42.00	84.00	105.00											47.00	94.00	135.00				42.00	84.00	105.00					47.00			47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	11		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								97.00	194.00	285.00					92.00	184.00	225.00											97.00	194.00	285.00				92.00	184.00	225.00					97.00			97.00			3.23	3.07		3.23	3.07	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	11		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	034	0	1	04	01	H7917_034_0	8		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								40.00	80.00	100.00					35.00	70.00	90.00											40.00	80.00	100.00				35.00	70.00	90.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								85.00	170.00	215.00					80.00	160.00	200.00											85.00	170.00	215.00				80.00	160.00	200.00					85.00			85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	034	0	1	04	01	H7917_034_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	035	0	1	04	01	H7917_035_0	9		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								40.00	80.00	100.00					35.00	70.00	90.00											40.00	80.00	100.00				35.00	70.00	90.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								85.00	170.00	215.00					80.00	160.00	200.00											85.00	170.00	215.00				80.00	160.00	200.00					85.00			85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	035	0	1	04	01	H7917_035_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	9		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	9		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	036	0	1	04	01	H7917_036_0	9		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	9		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								40.00	80.00	100.00					35.00	70.00	90.00											40.00	80.00	100.00				35.00	70.00	90.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	9		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								85.00	170.00	215.00					80.00	160.00	200.00											85.00	170.00	215.00				80.00	160.00	200.00					85.00			85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	036	0	1	04	01	H7917_036_0	9		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	8		Y	Preferred Generic	4	11	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		14	31								6.00	12.00	15.00					1.00	1.00	1.00											6.00	12.00	15.00				1.00	1.00	1.00					6.00			6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	037	0	1	04	01	H7917_037_0	8		Y	Generic	4	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								10.00	20.00	25.00					5.00	5.00	5.00											10.00	20.00	25.00				5.00	5.00	5.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								40.00	80.00	100.00					35.00	70.00	90.00											40.00	80.00	100.00				35.00	70.00	90.00					40.00			40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		14	31								85.00	170.00	215.00					80.00	160.00	200.00											85.00	170.00	215.00				80.00	160.00	200.00					85.00			85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	037	0	1	04	01	H7917_037_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				14	31												33							33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7925	001	0	1	01	01	H7925_001_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	001	0	1	01	01	H7925_001_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7925	002	0	1	01	01	H7925_002_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7971	003	0	1	04	01	H7971_003_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7971	003	0	1	04	01	H7971_003_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			5.00	10.00	15.00																10.00				10.00		0.33			0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7971	003	0	1	04	01	H7971_003_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7971	003	0	1	04	01	H7971_003_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				60.87	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7971	003	0	1	04	01	H7971_003_0	9		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				435.17	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7993	001	0	1	01	01	H7993_001_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7993	001	0	1	01	01	H7993_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	001	0	1	01	01	H7993_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1096.43	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7993	002	0	1	01	01	H7993_002_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7993	002	0	1	01	01	H7993_002_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	30.00	60.00	90.00																			30.00	60.00	75.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	002	0	1	01	01	H7993_002_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				899.87	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	003	0	1	01	01	H7993_003_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	003	0	1	01	01	H7993_003_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7993	003	0	1	01	01	H7993_003_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	003	0	1	01	01	H7993_003_0	8		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7993	003	0	1	01	01	H7993_003_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	40.00	80.00	120.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	003	0	1	01	01	H7993_003_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	99.00	198.00	297.00																			99.00	198.00	297.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	003	0	1	01	01	H7993_003_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1141.79	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7993	004	0	1	01	01	H7993_004_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	8		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H7993	004	0	1	01	01	H7993_004_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	30.00	60.00	90.00																			30.00	60.00	75.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	99.00	198.00	297.00																			99.00	198.00	297.00																99.00				99.00		3.30			3.30			3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7993	004	0	1	01	01	H7993_004_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				882.08	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8003	001	0	1	04	01	H8003_001_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	92.50																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				61.54	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	001	0	1	04	01	H8003_001_0	7		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	002	0	1	04	01	H8003_002_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	002	0	1	04	01	H8003_002_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8003	002	0	1	04	01	H8003_002_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	002	0	1	04	01	H8003_002_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	92.50																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	002	0	1	04	01	H8003_002_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				67.57	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	002	0	1	04	01	H8003_002_0	7		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	003	0	1	04	01	H8003_003_0	7		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	003	0	1	04	01	H8003_003_0	7		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8003	003	0	1	04	01	H8003_003_0	7		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	003	0	1	04	01	H8003_003_0	7		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	37.00	74.00	111.00																			37.00	74.00	92.50																37.00				37.00		1.23			1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	003	0	1	04	01	H8003_003_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				63.53	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	003	0	1	04	01	H8003_003_0	7		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	004	0	1	04	01	H8003_004_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	004	0	1	04	01	H8003_004_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8003	004	0	1	04	01	H8003_004_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	004	0	1	04	01	H8003_004_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	004	0	1	04	01	H8003_004_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				79.52	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	004	0	1	04	01	H8003_004_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	005	0	1	04	01	H8003_005_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	005	0	1	04	01	H8003_005_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	0.00																			5.00	10.00	0.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8003	005	0	1	04	01	H8003_005_0	9		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	005	0	1	04	01	H8003_005_0	9		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	005	0	1	04	01	H8003_005_0	9		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				79.26	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8003	005	0	1	04	01	H8003_005_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					2.00	4.00	0.00							0.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	10		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	10		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	002	0	1	01	01	H8010_002_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2252.04	33	33	33				2252.04	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	7		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	5.00					2.00	4.00	0.00							0.00																12.00				12.00			0.40	0.07				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	7		N	Generic	4	11	1	1	2	1		111	01	100		1				30	60	100	1	2			100				30		31											10.21	25	25	25				10.21	22	22	22						0															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01	100		1				30	60	100	1	2			100				30		31											174.52	25	25	25				174.52	22	22	22						22															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	100	1	2			100				30		31											223.06	25	25	25				223.06	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	003	0	1	01	01	H8010_003_0	7		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2123.86	25	25	25				2123.86	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	10		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	10		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	005	0	1	01	01	H8010_005_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2292.67	33	33	33				2292.67	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	10		N	Preferred Generic	4	11	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								7.00	10.00	5.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	10		N	Generic	4	11	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							0.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	10		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					40.00	80.00	120.00							110.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	10		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								100.00	200.00	300.00					95.00	190.00	285.00							275.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8010	008	0	1	01	01	H8010_008_0	10		N	Specialty Tier	4	11	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											2292.67	33	33	33				2292.67	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8016	001	0	1	48	05	H8016_001_0	5			Generic Drugs	4	01			1	1	111		01			1	30	60	90				1	2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.70	0.00	3.70			0.00	3.70			
H8016	001	0	1	48	05	H8016_001_0	5			Brand Drugs	4	10			2	1	111		01			1	30	60	90				1	2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	9.20	0.00	9.20			0.00	9.20			
H8016	001	0	1	48	05	H8016_001_0	5			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01			1	30	60	90				1	2							30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8019	001	0	1	01	01	H8019_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	001	0	1	01	01	H8019_001_0	7		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	001	0	1	01	01	H8019_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	001	0	1	01	01	H8019_001_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	001	0	1	01	01	H8019_001_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	001	0	1	01	01	H8019_001_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	001	0	1	01	01	H8019_001_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H8019	002	0	1	02	01	H8019_002_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	7		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	002	0	1	02	01	H8019_002_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H8019	004	0	1	01	01	H8019_004_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	004	0	1	01	01	H8019_004_0	7		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	004	0	1	01	01	H8019_004_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	004	0	1	01	01	H8019_004_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	004	0	1	01	01	H8019_004_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	004	0	1	01	01	H8019_004_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H8019	004	0	1	01	01	H8019_004_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H8026	001	0	1	48	05	H8026_001_0	2			Generic Drugs	4	11			1	1	111		10	111		1	30	60	90				2	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	2			Brand Drugs	4	11			2	1	111		10	111		1	30	60	90				2	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	2			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		10			1	30	60	90				1	2								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	4			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	4			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8064	002	0	1	04	01	H8064_002_0	4		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	4		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	0.00	0.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8064	002	0	1	04	01	H8064_002_0	4		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				94.48	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				294.37	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	004	0	1	04	01	H8064_004_0	4		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	004	0	1	04	01	H8064_004_0	4		Y	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8064	004	0	1	04	01	H8064_004_0	4		Y	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	004	0	1	04	01	H8064_004_0	4		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	004	0	1	04	01	H8064_004_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				94.44	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8064	004	0	1	04	01	H8064_004_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				294.28	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					8.00		24.00											20.00		60.00				8.00		0.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	001	0	1	04	01	H8087_001_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	002	0	1	04	01	H8087_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	003	0	1	04	01	H8087_003_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	003	0	1	04	01	H8087_003_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	003	0	1	04	01	H8087_003_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	003	0	1	04	01	H8087_003_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8087	003	0	1	04	01	H8087_003_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	001	0	1	01	01	H8130_001_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	4		N	Generic	4	11	1	2	2	3	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8130	001	0	1	01	01	H8130_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.22	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				539.28	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8133	001	0	1	01	01	H8133_001_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8133	003	0	1	01	01	H8133_003_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												28		28					28		28												28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8133	005	0	1	01	01	H8133_005_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	6.00	12.00	12.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	40.00																			0.00	0.00	0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	200.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	001	0	1	01	01	H8142_001_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	6.00																			0.00	0.00	0.00																3.00				3.00		0.10			0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	15.00	30.00	30.00																			0.00	0.00	0.00																15.00				15.00		0.50			0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	190.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	002	0	1	01	01	H8142_002_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	10		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	4.00																			0.00	0.00	0.00																2.00				2.00		0.07			0.00			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	10		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	12.00	24.00	24.00																			0.00	0.00	0.00																12.00				12.00		0.40			0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	10		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	90.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	190.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	003	0	1	01	01	H8142_003_0	10		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	8		Y	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	6.00	12.00	12.00																			0.00	0.00	0.00																6.00				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	8		Y	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	40.00																			0.00	0.00	0.00																20.00				20.00		0.67			0.00			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	47.00	94.00	94.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	200.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8142	007	0	1	01	01	H8142_007_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	2			Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	2			Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	2			Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	2			Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	2			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	2			Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	2			Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	2			Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	2			Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	2			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	3			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	001	0	1	01	01	H8173_001_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	001	0	1	01	01	H8173_001_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8173	001	0	1	01	01	H8173_001_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	001	0	1	01	01	H8173_001_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8173	001	0	1	01	01	H8173_001_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	001	0	1	01	01	H8173_001_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	001	0	1	01	01	H8173_001_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1102.03	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	8		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	8		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8173	002	0	1	01	01	H8173_002_0	8		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	8		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8173	002	0	1	01	01	H8173_002_0	8		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	002	0	1	01	01	H8173_002_0	8		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				906.02	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	003	0	1	01	01	H8173_003_0	7		Y	Preferred Generic	4	11	1	2	1	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	003	0	1	01	01	H8173_003_0	7		Y	Preferred Generic	4	11	1	2	1	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8173	003	0	1	01	01	H8173_003_0	7		Y	Generic	4	11	3	2	2	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	003	0	1	01	01	H8173_003_0	7		Y	Generic	4	11	3	2	2	3	111		01	111		1	30	60	100				1	2	30	60	100				30		31	5.00	10.00	15.00																			0.00	0.00	0.00																5.00				5.00		0.17			0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H8173	003	0	1	01	01	H8173_003_0	7		Y	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	003	0	1	01	01	H8173_003_0	7		Y	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	100				1	2	30	60	100				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8173	003	0	1	01	01	H8173_003_0	7		Y	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				740.64	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.45			1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				99.32	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	001	0	1	01	01	H8176_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				435.96	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	002	0	1	01	01	H8176_002_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	002	0	1	01	01	H8176_002_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	002	0	1	01	01	H8176_002_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.42			1.42			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	002	0	1	01	01	H8176_002_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				99.03	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8176	002	0	1	01	01	H8176_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				435.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_001_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					2.00	4.00	0.00																12.00				0.00			0.40	0.00	0.07			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					8.00	16.00	24.00					8.00	16.00	0.00																18.00				8.00			0.60	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				37.00			1.57	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8181	001	0	1	04	01	H8181_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	2		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	2		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8189	001	0	1	01	01	H8189_001_0	2		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	2		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				97.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8197	001	0	1	48	05	H8197_001_0	7			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	001	0	1	48	05	H8197_001_0	7			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	001	0	1	48	05	H8197_001_0	7			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8211	001	0	1	04	01	H8211_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	001	0	1	04	01	H8211_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	001	0	1	04	01	H8211_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				364.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	002	0	1	04	01	H8211_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	002	0	1	04	01	H8211_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				342.00	31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	006	0	1	04	01	H8211_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	006	0	1	04	01	H8211_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				315.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8211	007	0	1	04	01	H8211_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8211	007	0	1	04	01	H8211_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				282.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8213	001	0	1	48	05	H8213_001_0	4			Generic Drugs	4	01			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8213	001	0	1	48	05	H8213_001_0	4			Brand Drugs	4	11			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8213	001	0	1	48	05	H8213_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8225	001	0	1	01	01	H8225_001_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	001	0	1	01	01	H8225_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	002	0	1	01	01	H8225_002_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	003	0	1	01	01	H8225_003_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8225	004	0	1	01	01	H8225_004_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8258	001	0	1	48	05	H8258_001_0	7			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	7			Brand Drugs	4	10			2	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	9.20			0.00	9.20	0.00	9.20			
H8258	001	0	1	48	05	H8258_001_0	7			Non-Medicare Rx Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	7			Non-Medicare OTC Drugs	4	11			4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8280	001	0	1	01	01	H8280_001_0	6		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	001	0	1	01	01	H8280_001_0	6		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.93	25		25				7.93	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	001	0	1	01	01	H8280_001_0	6		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											109.76	25		25				109.76	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	001	0	1	01	01	H8280_001_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											69.44	25		25				69.44	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	001	0	1	01	01	H8280_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											606.55	25						606.55	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	001	0	1	01	01	H8280_001_0	6		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	002	0	1	01	01	H8280_002_0	6		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	002	0	1	01	01	H8280_002_0	6		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.18	25		25				7.18	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	002	0	1	01	01	H8280_002_0	6		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											103.19	25		25				103.19	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	002	0	1	01	01	H8280_002_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											63.71	25		25				63.71	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	002	0	1	01	01	H8280_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											576.34	25						576.34	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8280	002	0	1	01	01	H8280_002_0	6		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8293	001	0	1	01	01	H8293_001_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					2.00		6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8293	001	0	1	01	01	H8293_001_0	5		Y	Generic	4	01	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					5.00		15.00											12.00		36.00				5.00		15.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8293	001	0	1	01	01	H8293_001_0	5		Y	Preferred Brand	4	10	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8293	001	0	1	01	01	H8293_001_0	5		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8293	001	0	1	01	01	H8293_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31												33		33					33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8332	001	0	1	01	01	H8332_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	001	0	1	01	01	H8332_001_0	4		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8332	001	0	1	01	01	H8332_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	001	0	1	01	01	H8332_001_0	4		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8332	001	0	1	01	01	H8332_001_0	4		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	001	0	1	01	01	H8332_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	001	0	1	01	01	H8332_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											658.86	30						485.43	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	002	0	1	01	01	H8332_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	002	0	1	01	01	H8332_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8332	002	0	1	01	01	H8332_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	002	0	1	01	01	H8332_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8332	002	0	1	01	01	H8332_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	002	0	1	01	01	H8332_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8332	002	0	1	01	01	H8332_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											657.14	30						484.25	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8343	001	0	1	04	01	H8343_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	270.00	270.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	001	0	1	04	01	H8343_001_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8343	002	0	1	04	01	H8343_002_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					90.00	180.00	270.00					90.00	270.00	270.00																100.00				100.00			3.33	3.00	3.00			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	002	0	1	04	01	H8343_002_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8343	003	0	1	04	01	H8343_003_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8343	003	0	1	04	01	H8343_003_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8364	002	0	1	04	01	H8364_002_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8364	002	0	1	04	01	H8364_002_0	5		N	Generic	4	11	1	1	2	1		110	01	110		1				30		90	1	2	30		90				30		31											7.28	25		25				7.28	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8364	002	0	1	04	01	H8364_002_0	5		N	Preferred Brand	4	11	1	1	3	1		110	01	110		1				30		90	1	2	30		90				30		31											104.43	25		25				104.43	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8364	002	0	1	04	01	H8364_002_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											64.75	25		25				64.75	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8364	002	0	1	04	01	H8364_002_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											583.12	25						583.12	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8364	002	0	1	04	01	H8364_002_0	5		N	Select Care Drugs	4	11	3	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	011	0	1	01	01	H8390_011_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	011	0	1	01	01	H8390_011_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	011	0	1	01	01	H8390_011_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	011	0	1	01	01	H8390_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	011	0	1	01	01	H8390_011_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					32																																					32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	011	0	1	01	01	H8390_011_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	012	0	1	01	01	H8390_012_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	012	0	1	01	01	H8390_012_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	012	0	1	01	01	H8390_012_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	012	0	1	01	01	H8390_012_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	012	0	1	01	01	H8390_012_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	012	0	1	01	01	H8390_012_0	4		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	013	0	1	01	01	H8390_013_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	013	0	1	01	01	H8390_013_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	013	0	1	01	01	H8390_013_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	013	0	1	01	01	H8390_013_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	013	0	1	01	01	H8390_013_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					31																																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	013	0	1	01	01	H8390_013_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	014	0	1	01	01	H8390_014_0	3		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	014	0	1	01	01	H8390_014_0	3		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	014	0	1	01	01	H8390_014_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	014	0	1	01	01	H8390_014_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	014	0	1	01	01	H8390_014_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	014	0	1	01	01	H8390_014_0	3		N	Select Care Drugs	4	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	015	0	1	01	01	H8390_015_0	3		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.72	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	015	0	1	01	01	H8390_015_0	3		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.85	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	015	0	1	01	01	H8390_015_0	3		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				89.26	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	015	0	1	01	01	H8390_015_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				39.16	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	015	0	1	01	01	H8390_015_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				460.81	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	015	0	1	01	01	H8390_015_0	3		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	016	0	1	01	01	H8390_016_0	3		N	Preferred Generic	3	11	1	1	1	1	111		01	100		1	30	60	90				1	2			90				30		31				1.73	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	016	0	1	01	01	H8390_016_0	3		N	Generic	3	11	1	1	2	1	111		01	100		1	30	60	90				1	2			90				30		31				6.85	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	016	0	1	01	01	H8390_016_0	3		N	Preferred Brand	3	11	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				89.26	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	016	0	1	01	01	H8390_016_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				39.16	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	016	0	1	01	01	H8390_016_0	3		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				460.69	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8390	016	0	1	01	01	H8390_016_0	3		N	Select Care Drugs	3	11	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8423	001	0	1	48	05	H8423_001_0	5			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8423	001	0	1	48	05	H8423_001_0	5			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8432	007	0	1	01	01	H8432_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	007	0	1	01	01	H8432_007_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								6.00	12.00	18.00					6.00	12.00	18.00					6.00	18.00	18.00																6.00				6.00			0.20	0.20	0.20			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	007	0	1	01	01	H8432_007_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	008	5	1	01	01	H8432_008_5	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	5	1	01	01	H8432_008_5	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	5	1	01	01	H8432_008_5	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	5	1	01	01	H8432_008_5	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	5	1	01	01	H8432_008_5	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	6	1	01	01	H8432_008_6	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	6	1	01	01	H8432_008_6	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	6	1	01	01	H8432_008_6	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	6	1	01	01	H8432_008_6	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	6	1	01	01	H8432_008_6	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	7	1	01	01	H8432_008_7	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	7	1	01	01	H8432_008_7	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	7	1	01	01	H8432_008_7	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	7	1	01	01	H8432_008_7	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	008	7	1	01	01	H8432_008_7	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	009	0	1	01	01	H8432_009_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	009	0	1	01	01	H8432_009_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	009	0	1	01	01	H8432_009_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	009	0	1	01	01	H8432_009_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	009	0	1	01	01	H8432_009_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	010	0	1	01	01	H8432_010_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	010	0	1	01	01	H8432_010_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	010	0	1	01	01	H8432_010_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	120.00	120.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	010	0	1	01	01	H8432_010_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	010	0	1	01	01	H8432_010_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	011	0	1	01	01	H8432_011_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	011	0	1	01	01	H8432_011_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	011	0	1	01	01	H8432_011_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	011	0	1	01	01	H8432_011_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	011	0	1	01	01	H8432_011_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	015	0	1	02	01	H8432_015_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	015	0	1	02	01	H8432_015_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	015	0	1	02	01	H8432_015_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	015	0	1	02	01	H8432_015_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								98.00	196.00	294.00					93.00	186.00	279.00					93.00	279.00	279.00																98.00				98.00			3.27	3.10	3.10			2.88	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	015	0	1	02	01	H8432_015_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	016	0	1	01	01	H8432_016_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	016	0	1	01	01	H8432_016_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	027	0	1	01	01	H8432_027_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	027	0	1	01	01	H8432_027_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	027	0	1	01	01	H8432_027_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	027	0	1	01	01	H8432_027_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	027	0	1	01	01	H8432_027_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	027	0	1	01	01	H8432_027_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	027	0	1	01	01	H8432_027_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	028	0	1	01	01	H8432_028_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8432	028	0	1	01	01	H8432_028_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	028	0	1	01	01	H8432_028_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	032	0	1	01	01	H8432_032_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	032	0	1	01	01	H8432_032_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	032	0	1	01	01	H8432_032_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	032	0	1	01	01	H8432_032_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	032	0	1	01	01	H8432_032_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	032	0	1	01	01	H8432_032_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	032	0	1	01	01	H8432_032_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	033	0	1	01	01	H8432_033_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	033	0	1	01	01	H8432_033_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	033	0	1	01	01	H8432_033_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	033	0	1	01	01	H8432_033_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								99.00	198.00	297.00					94.00	188.00	282.00					94.00	282.00	282.00																99.00				99.00			3.30	3.13	3.13			2.91	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	033	0	1	01	01	H8432_033_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	033	0	1	01	01	H8432_033_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	033	0	1	01	01	H8432_033_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	034	0	1	01	01	H8432_034_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	034	0	1	01	01	H8432_034_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								6.00	12.00	18.00					6.00	12.00	18.00					6.00	18.00	18.00																6.00				6.00			0.20	0.20	0.20			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	034	0	1	01	01	H8432_034_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	035	0	1	01	01	H8432_035_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	035	0	1	01	01	H8432_035_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8432	035	0	1	01	01	H8432_035_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					15.00	30.00	45.00					15.00	45.00	45.00																15.00				15.00			0.50	0.50	0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	035	0	1	01	01	H8432_035_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	035	0	1	01	01	H8432_035_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	035	0	1	01	01	H8432_035_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	035	0	1	01	01	H8432_035_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	035	0	1	01	01	H8432_035_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	038	1	1	01	01	H8432_038_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	1	1	01	01	H8432_038_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	1	1	01	01	H8432_038_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	1	1	01	01	H8432_038_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	1	1	01	01	H8432_038_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	2	1	01	01	H8432_038_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	2	1	01	01	H8432_038_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	2	1	01	01	H8432_038_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	111.00	111.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	2	1	01	01	H8432_038_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	038	2	1	01	01	H8432_038_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8432	039	1	1	01	01	H8432_039_1	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	039	1	1	01	01	H8432_039_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								5.00	10.00	15.00					5.00	10.00	15.00					5.00	15.00	15.00																5.00				5.00			0.17	0.17	0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	1	1	01	01	H8432_039_1	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	039	2	1	01	01	H8432_039_2	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	039	2	1	01	01	H8432_039_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								5.00	10.00	15.00					5.00	10.00	15.00					5.00	15.00	15.00																5.00				5.00			0.17	0.17	0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	039	2	1	01	01	H8432_039_2	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8452	001	0	1	48	05	H8452_001_0	6			Generic Drugs	4	11			1	1	111		01	100		1	30	60	90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	6			Brand Drugs	4	11			2	1	111		01	100		1	30	60	90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	6			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8547	001	0	1	01	01	H8547_001_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8547	001	0	1	01	01	H8547_001_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8547	001	0	1	01	01	H8547_001_0	7		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8547	001	0	1	01	01	H8547_001_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8547	001	0	1	01	01	H8547_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8547	001	0	1	01	01	H8547_001_0	7		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8552	020	0	1	04	01	H8552_020_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	3.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								11.00	22.00	33.00					6.00	12.00	18.00					6.00	18.00	18.00																11.00				11.00			0.37	0.20	0.20			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8552	029	0	1	04	01	H8552_029_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	12.00	12.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	029	0	1	04	01	H8552_029_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8552	030	0	1	04	01	H8552_030_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								36.00	72.00	108.00					36.00	72.00	108.00					36.00	108.00	108.00																36.00				36.00			1.20	1.20	1.20			1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	030	0	1	04	01	H8552_030_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8553	001	0	1	04	01	H8553_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	001	0	1	04	01	H8553_001_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H8553	001	0	1	04	01	H8553_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	001	0	1	04	01	H8553_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	001	0	1	04	01	H8553_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	001	0	1	04	01	H8553_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	003	0	1	04	01	H8553_003_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	003	0	1	04	01	H8553_003_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H8553	003	0	1	04	01	H8553_003_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	003	0	1	04	01	H8553_003_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	003	0	1	04	01	H8553_003_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.65	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8553	003	0	1	04	01	H8553_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	8		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	8		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8554	001	0	1	01	01	H8554_001_0	8		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	8		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	8		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												29		29					29		29												29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4		N	Preferred Generic	4	11	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8578	001	0	1	01	01	H8578_001_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	26																																					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	016	0	1	02	01	H8578_016_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	016	0	1	02	01	H8578_016_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	016	0	1	02	01	H8578_016_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	016	0	1	02	01	H8578_016_0	4		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	016	0	1	02	01	H8578_016_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	4		N	Generic	4	11	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	4		N	Non-Preferred Drug	4	11	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8578	017	0	1	01	01	H8578_017_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				1.00	26																																					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8597	001	0	1	01	01	H8597_001_0	4		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	001	0	1	01	01	H8597_001_0	4		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	001	0	1	01	01	H8597_001_0	4		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											32.63	25	25	25				34.54	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	001	0	1	01	01	H8597_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.95	35	35	35				53.30	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	001	0	1	01	01	H8597_001_0	4		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											515.88	29						407.99	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	002	0	1	01	01	H8597_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	002	0	1	01	01	H8597_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	002	0	1	01	01	H8597_002_0	2		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											31.91	25	25	25				33.51	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	002	0	1	01	01	H8597_002_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.92	35	35	35				52.74	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	002	0	1	01	01	H8597_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											504.02	29						400.88	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	003	0	1	01	01	H8597_003_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	003	0	1	01	01	H8597_003_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	003	0	1	01	01	H8597_003_0	2		N	Preferred Brand	4	11	1	1	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											30.39	25	25	25				31.17	25	25	25										25	25	25				25	25	25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	003	0	1	01	01	H8597_003_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.93	35	35	35				51.19	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8597	003	0	1	01	01	H8597_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											506.93	29						399.19	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8604	010	0	1	04	01	H8604_010_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	5		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							0.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								47.00		141.00					47.00		141.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		300.00					100.00		300.00							200.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	4		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	4		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							0.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								47.00		141.00					47.00		141.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		300.00					100.00		300.00							200.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	4		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	4		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							0.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								47.00		141.00					47.00		141.00							94.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								100.00		300.00					100.00		300.00							200.00																100.00				100.00			3.33	3.33				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	5		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8634	002	0	1	04	01	H8634_002_0	5		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	5		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												26		26					26		26												26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8634	003	0	1	04	01	H8634_003_0	7		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	7		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8634	004	0	1	04	01	H8634_004_0	6		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8634	007	0	1	04	01	H8634_007_0	7		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	007	0	1	04	01	H8634_007_0	7		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	8		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	8		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8634	008	0	1	04	01	H8634_008_0	8		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					13.00		39.00													40.00						26.00				20.00				20.00			0.67	0.43				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	8		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													94.00						80.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	008	0	1	04	01	H8634_008_0	8		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	003	0	1	01	01	H8649_003_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	003	0	1	01	01	H8649_003_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	003	0	1	01	01	H8649_003_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	003	0	1	01	01	H8649_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	003	0	1	01	01	H8649_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	003	0	1	01	01	H8649_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											685.70	33						488.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	008	0	1	01	01	H8649_008_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	008	0	1	01	01	H8649_008_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	008	0	1	01	01	H8649_008_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	008	0	1	01	01	H8649_008_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	008	0	1	01	01	H8649_008_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	008	0	1	01	01	H8649_008_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8649	008	0	1	01	01	H8649_008_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											639.00	29						491.46	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H8677	001	0	1	48	05	H8677_001_0	5			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	001	0	1	48	05	H8677_001_0	5			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	001	0	1	48	05	H8677_001_0	5			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	5			Generic Drugs	4	01			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	5			Brand Drugs	4	11			2	1	111		01	111		1	31	60	90				2	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	5			Non-Medicare Rx/OTC Drugs	4	11			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8711	001	0	1	04	01	H8711_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	001	0	1	04	01	H8711_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	001	0	1	04	01	H8711_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	001	0	1	04	01	H8711_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.33	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	001	0	1	04	01	H8711_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	002	0	1	04	01	H8711_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	002	0	1	04	01	H8711_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	002	0	1	04	01	H8711_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	002	0	1	04	01	H8711_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8711	002	0	1	04	01	H8711_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8748	002	0	1	02	01	H8748_002_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	02	01	H8748_002_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				391.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		8.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8748	008	0	1	02	01	H8748_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	02	01	H8748_008_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				334.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8748	009	0	1	02	01	H8748_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	02	01	H8748_009_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				395.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		4.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		16.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8748	025	0	1	02	01	H8748_025_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	025	0	1	02	01	H8748_025_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				362.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	4		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	001	0	1	01	01	H8764_001_0	4		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H8764	001	0	1	01	01	H8764_001_0	4		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	001	0	1	01	01	H8764_001_0	4		N	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H8764	001	0	1	01	01	H8764_001_0	4		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	001	0	1	01	01	H8764_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	001	0	1	01	01	H8764_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	001	0	1	01	01	H8764_001_0	4		N	Select Diabetic Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	5		N	Preferred Generic	4	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	5		N	Preferred Generic	4	01	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H8764	002	0	1	02	01	H8764_002_0	5		N	Generic	4	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	5		N	Generic	4	01	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H8764	002	0	1	02	01	H8764_002_0	5		N	Preferred Brand	4	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	42.00		126.00																					84.00																42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	002	0	1	02	01	H8764_002_0	5		N	Select Diabetic Drugs	4	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	4		N	Preferred Generic	3	01	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	4		N	Generic	3	01	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	18.00		54.00																					36.00																18.00				18.00		0.60						0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	4		N	Preferred Brand	3	10	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	4		N	Non-Preferred Drug	3	11	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	4		N	Specialty Tier	3	11	1	1	5	1	010		01			1	30														30		31				965.12	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8764	003	0	1	01	01	H8764_003_0	4		N	Select Diabetic Drugs	3	11	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H8768	003	0	1	04	01	H8768_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	003	0	1	04	01	H8768_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	003	0	1	04	01	H8768_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				349.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	005	0	1	04	01	H8768_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	005	0	1	04	01	H8768_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				329.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	006	0	1	04	01	H8768_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	006	0	1	04	01	H8768_006_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	006	0	1	04	01	H8768_006_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	006	0	1	04	01	H8768_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	006	0	1	04	01	H8768_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	006	0	1	04	01	H8768_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				382.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	007	0	1	04	01	H8768_007_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	007	0	1	04	01	H8768_007_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				329.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	008	0	1	04	01	H8768_008_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	008	0	1	04	01	H8768_008_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				329.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	009	0	1	04	01	H8768_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	009	0	1	04	01	H8768_009_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				456.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	010	0	1	04	01	H8768_010_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	010	0	1	04	01	H8768_010_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											302.00	28						195.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	011	0	1	04	01	H8768_011_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	011	0	1	04	01	H8768_011_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											297.00	28						232.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	012	0	1	04	01	H8768_012_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	012	0	1	04	01	H8768_012_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	012	0	1	04	01	H8768_012_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	012	0	1	04	01	H8768_012_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	012	0	1	04	01	H8768_012_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	012	0	1	04	01	H8768_012_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				232.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	013	0	1	04	01	H8768_013_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	013	0	1	04	01	H8768_013_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				255.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	014	0	1	04	01	H8768_014_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	014	0	1	04	01	H8768_014_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	014	0	1	04	01	H8768_014_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	014	0	1	04	01	H8768_014_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	014	0	1	04	01	H8768_014_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	014	0	1	04	01	H8768_014_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											355.00	29						361.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	3		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	3		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					5.00		10.00													60.00						10.00				20.00				20.00			0.66	0.16				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	015	0	1	04	01	H8768_015_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					47.00		131.00													141.00						131.00				47.00				47.00			1.56	1.56				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					100.00		290.00													300.00						290.00				100.00				100.00			3.33	3.33				3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	015	0	1	04	01	H8768_015_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											202.00	28						224.00	28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	016	0	1	04	01	H8768_016_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	016	0	1	04	01	H8768_016_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				261.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	017	1	1	04	01	H8768_017_1	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	1	1	04	01	H8768_017_1	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				485.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	017	2	1	04	01	H8768_017_2	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	017	2	1	04	01	H8768_017_2	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				485.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	022	0	1	04	01	H8768_022_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	022	0	1	04	01	H8768_022_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				172.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	023	0	1	04	01	H8768_023_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	023	0	1	04	01	H8768_023_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				441.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	024	0	1	04	01	H8768_024_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	024	0	1	04	01	H8768_024_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	024	0	1	04	01	H8768_024_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	024	0	1	04	01	H8768_024_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	024	0	1	04	01	H8768_024_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	024	0	1	04	01	H8768_024_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				517.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	026	0	1	04	01	H8768_026_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	026	0	1	04	01	H8768_026_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				519.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	027	0	1	04	01	H8768_027_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	027	0	1	04	01	H8768_027_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	027	0	1	04	01	H8768_027_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	027	0	1	04	01	H8768_027_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	027	0	1	04	01	H8768_027_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	027	0	1	04	01	H8768_027_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				414.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	029	0	1	04	01	H8768_029_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	029	0	1	04	01	H8768_029_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	029	0	1	04	01	H8768_029_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	029	0	1	04	01	H8768_029_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	029	0	1	04	01	H8768_029_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	029	0	1	04	01	H8768_029_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				273.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	10.00		20.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
H8768	030	0	1	04	01	H8768_030_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8768	030	0	1	04	01	H8768_030_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				344.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		2.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		94.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											58.00	50		50				52.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	001	0	1	04	01	H8783_001_0	6		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1289.00	25		25				1289.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	6		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		2.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	6		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								17.00		51.00					7.00		21.00											17.00		51.00				7.00		14.00					17.00			17.00			0.57	0.23		0.57	0.23	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	6		Y	Preferred Brand	4	11	1	2	3	1		110	10		110	1				30		90	1	2				30		90		29	31								45.00		135.00					35.00		105.00											45.00		135.00				35.00		70.00					45.00			45.00			1.50	1.17		1.50	1.17	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											62.00	50		50				56.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	002	0	1	04	01	H8783_002_0	6		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1976.00	28		28				1976.00	28		28										28		28				28		28				28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	003	0	1	04	01	H8783_003_0	7		Y	Preferred Generic	4	11	1	2	1	1		110	10		110	1				30		90	1	2				30		90		29	31								12.00		36.00					3.00		9.00											12.00		36.00				3.00		6.00					12.00			12.00			0.40	0.10		0.40	0.10	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	003	0	1	04	01	H8783_003_0	7		Y	Generic	4	11	1	2	2	1		110	10		110	1				30		90	1	2				30		90		29	31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		20.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	003	0	1	04	01	H8783_003_0	7		Y	Preferred Brand	4	11	1	1	3	1		110	10		110	1				30		90	1	2				30		90		29	31											137.00	25		25				93.00	17		17										25		25				17		17				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	003	0	1	04	01	H8783_003_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1		110	10		110	1				30		90	1	2				30		90		29	31											50.00	50		50				45.00	45		45										50		50				45		45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8783	003	0	1	04	01	H8783_003_0	7		Y	Specialty Tier	4	11	1	1	5	1		110	10		110	1				30		90	1	2				30		90		29	31											1589.00	25		25				1589.00	25		25										25		25				25		25				25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8786	001	0	1	48	05	H8786_001_0	12			Generic Drugs	4	11			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8786	001	0	1	48	05	H8786_001_0	12			Brand Drugs	4	11			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	9.20			0.00	9.20	0.00	9.20			
H8786	001	0	1	48	05	H8786_001_0	12			Non-Medicare Rx Drugs	4	11			3	1	010		10			1	31															10	34																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8786	001	0	1	48	05	H8786_001_0	12			Non-Medicare OTC Drugs	4	11			4	1	010		10			1	31															10	34																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8797	002	0	1	01	01	H8797_002_0	4		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2.00	4.00	6.00																																						2.00			2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8797	002	0	1	01	01	H8797_002_0	4		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8797	002	0	1	01	01	H8797_002_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8797	002	0	1	01	01	H8797_002_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8797	002	0	1	01	01	H8797_002_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				1033.69	25																																						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8849	001	0	1	01	01	H8849_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	001	0	1	01	01	H8849_001_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	001	0	1	01	01	H8849_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	001	0	1	01	01	H8849_001_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H8849	002	0	1	01	01	H8849_002_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	002	0	1	01	01	H8849_002_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		34	7.50	15.00	22.50																			7.50	15.00	15.00																7.50				7.50		0.25			0.25			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	002	0	1	01	01	H8849_002_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		34	85.00	170.00	255.00																			85.00	170.00	170.00																85.00				85.00		2.83			2.83			2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		34					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	002	0	1	01	01	H8849_002_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	100				1	2	30	60	100				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H8849	003	0	1	01	01	H8849_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	003	0	1	01	01	H8849_003_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	003	0	1	01	01	H8849_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	003	0	1	01	01	H8849_003_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	004	0	1	01	01	H8849_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	004	0	1	01	01	H8849_004_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	004	0	1	01	01	H8849_004_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	004	0	1	01	01	H8849_004_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	005	0	1	01	01	H8849_005_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	005	0	1	01	01	H8849_005_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								12.50	25.00	37.50					7.50	15.00	22.50					7.50	15.00	15.00																12.50				12.50			0.42	0.25	0.25			0.37	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	005	0	1	01	01	H8849_005_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	80.00																45.00				45.00			1.50	1.33	1.33			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								95.00	190.00	285.00					85.00	170.00	255.00					85.00	170.00	170.00																95.00				95.00			3.17	2.83	2.83			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	005	0	1	01	01	H8849_005_0	5		N	Select Care Drugs	4	11	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	006	0	1	01	01	H8849_006_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	006	0	1	01	01	H8849_006_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	007	0	1	01	01	H8849_007_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	007	0	1	01	01	H8849_007_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	007	0	1	01	01	H8849_007_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	007	0	1	01	01	H8849_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	007	0	1	01	01	H8849_007_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	007	0	1	01	01	H8849_007_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	007	0	1	01	01	H8849_007_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	1	1	01	01	H8849_008_1	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	1	1	01	01	H8849_008_1	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	2	1	01	01	H8849_008_2	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	2	1	01	01	H8849_008_2	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	3	1	01	01	H8849_008_3	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	3	1	01	01	H8849_008_3	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	4	1	01	01	H8849_008_4	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	4	1	01	01	H8849_008_4	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	5	1	01	01	H8849_008_5	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	5	1	01	01	H8849_008_5	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	008	6	1	01	01	H8849_008_6	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	15.00	15.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	126.00	126.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	008	6	1	01	01	H8849_008_6	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	009	0	1	01	01	H8849_009_0	5		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	009	0	1	01	01	H8849_009_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	010	1	1	01	01	H8849_010_1	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	010	1	1	01	01	H8849_010_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	1	1	01	01	H8849_010_1	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	010	2	1	01	01	H8849_010_2	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	7		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	010	2	1	01	01	H8849_010_2	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	2	1	01	01	H8849_010_2	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	010	3	1	01	01	H8849_010_3	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	010	3	1	01	01	H8849_010_3	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	3	1	01	01	H8849_010_3	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	010	4	1	01	01	H8849_010_4	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	010	4	1	01	01	H8849_010_4	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	4	1	01	01	H8849_010_4	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	010	5	1	01	01	H8849_010_5	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	010	5	1	01	01	H8849_010_5	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	5	1	01	01	H8849_010_5	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	010	6	1	01	01	H8849_010_6	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	010	6	1	01	01	H8849_010_6	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	010	6	1	01	01	H8849_010_6	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	011	1	1	01	01	H8849_011_1	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	011	1	1	01	01	H8849_011_1	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	1	1	01	01	H8849_011_1	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	011	2	1	01	01	H8849_011_2	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	011	2	1	01	01	H8849_011_2	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	2	1	01	01	H8849_011_2	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	011	3	1	01	01	H8849_011_3	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	011	3	1	01	01	H8849_011_3	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	3	1	01	01	H8849_011_3	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	011	4	1	01	01	H8849_011_4	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	011	4	1	01	01	H8849_011_4	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	4	1	01	01	H8849_011_4	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	011	5	1	01	01	H8849_011_5	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	011	5	1	01	01	H8849_011_5	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	5	1	01	01	H8849_011_5	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8849	011	6	1	01	01	H8849_011_6	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H8849	011	6	1	01	01	H8849_011_6	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8849	011	6	1	01	01	H8849_011_6	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8889	001	0	1	04	01	H8889_001_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_001_0	4		Y	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							0.00																20.00				9.00			0.67	0.30				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_001_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_001_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											72.09	50		50				73.47	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	001	0	1	04	01	H8889_001_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	3		Y	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					8.00		24.00							0.00																20.00				8.00			0.67	0.27				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											72.64	50		50				78.51	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	002	0	1	04	01	H8889_002_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	4		Y	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	4		Y	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							0.00																20.00				9.00			0.67	0.30				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											69.04	50		50				69.78	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	003	0	1	04	01	H8889_003_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	3		N	Preferred Generic	3	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					5.00		15.00							0.00																15.00				5.00			0.50	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	3		N	Generic	3	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					12.00		36.00							26.00																20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											87.44	50		50				80.81	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	004	0	1	04	01	H8889_004_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	4		N	Preferred Generic	4	01	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					0.00		0.00							0.00																10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	4		N	Generic	4	01	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							0.00																20.00				9.00			0.67	0.30				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					47.00		141.00							131.00																47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											93.01	50		50				71.63	50		50						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8889	005	0	1	04	01	H8889_005_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	2		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	2		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					10.00		30.00											20.00		60.00				10.00		0.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	004	0	1	01	01	H8908_004_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	005	0	1	01	01	H8908_005_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	7		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	7		N	Preferred Generic	4	11	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8961	001	0	1	01	01	H8961_001_0	7		N	Generic	4	11	3	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	7		N	Generic	4	11	3	2	2	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		1
H8961	001	0	1	01	01	H8961_001_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	30.00		90.00																			30.00		90.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	75.00		225.00																			75.00		225.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8961	001	0	1	01	01	H8961_001_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				838.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	4.00	8.00	12.00																																						4.00			4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	5		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8967	002	0	1	01	01	H8967_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	14	1	01	01	H9001_030_14	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	14	1	01	01	H9001_030_14	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	14	1	01	01	H9001_030_14	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	14	1	01	01	H9001_030_14	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	14	1	01	01	H9001_030_14	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	14	1	01	01	H9001_030_14	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	15	1	01	01	H9001_030_15	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	16	1	01	01	H9001_030_16	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	030	17	1	01	01	H9001_030_17	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	14	1	01	01	H9001_031_14	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	15	1	01	01	H9001_031_15	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	16	1	01	01	H9001_031_16	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	031	17	1	01	01	H9001_031_17	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				0.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	28.00				9.00	18.00	18.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	94.00				42.00	84.00	84.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	200.00				95.00	190.00	190.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	14	1	01	01	H9001_032_14	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				0.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	28.00				9.00	18.00	18.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	94.00				42.00	84.00	84.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	200.00				95.00	190.00	190.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	15	1	01	01	H9001_032_15	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				0.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	28.00				9.00	18.00	18.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	94.00				42.00	84.00	84.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	200.00				95.00	190.00	190.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	16	1	01	01	H9001_032_16	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	14.00				0.00	0.00	0.00				0.00				0.00			0.23	0.00		0.23	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00	28.00	28.00				9.00	18.00	18.00				9.00				9.00			0.47	0.30		0.47	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	94.00				42.00	84.00	84.00				42.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	200.00				95.00	190.00	190.00				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	032	17	1	01	01	H9001_032_17	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	14	1	01	01	H9001_034_14	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	15	1	01	01	H9001_034_15	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	16	1	01	01	H9001_034_16	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	034	17	1	01	01	H9001_034_17	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	035	0	1	01	01	H9001_035_0	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	036	0	1	01	01	H9001_036_0	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					0.00	0.00	0.00											6.00	12.00	12.00				0.00	0.00	0.00				0.00				0.00			0.20	0.00		0.20	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	24.00				7.00	14.00	14.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								42.00	84.00	126.00					37.00	74.00	111.00											42.00	84.00	84.00				37.00	74.00	74.00				37.00				37.00			1.40	1.23		1.40	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	182.00				86.00	172.00	172.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9001	037	0	1	01	01	H9001_037_0	4		N	Select Care Drugs	4	11	1	2	6	1		010	01		010	1				30								30			30		31								0.00							0.00													0.00						0.00						0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9003	001	0	1	01	01	H9003_001_0	10		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	10		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	10		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				862.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	10		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				859.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	007	0	1	01	01	H9003_007_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					4.00	8.00	12.00											19.00	38.00	57.00				4.00	8.00	8.00				19.00				19.00			0.63	0.13		0.63	0.13	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	01	01	H9003_007_0	9		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					4.00	8.00	12.00											19.00	38.00	57.00				4.00	8.00	8.00				19.00				19.00			0.63	0.13		0.63	0.13	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	007	0	1	01	01	H9003_007_0	9		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.66	0.33		0.66	0.33	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	01	01	H9003_007_0	9		N	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.66	0.33		0.66	0.33	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	007	0	1	01	01	H9003_007_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	01	01	H9003_007_0	9		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	186.00				100.00				100.00			3.33	3.10		3.33	3.10	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	01	01	H9003_007_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											713.00	30	30	30				713.00	30	30	30										30	30	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	01	01	H9003_007_0	9		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	007	0	1	01	01	H9003_007_0	9		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	008	0	1	01	01	H9003_008_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					4.00	8.00	12.00											19.00	38.00	57.00				4.00	8.00	8.00				19.00				19.00			0.63	0.13		0.63	0.13	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	01	01	H9003_008_0	9		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								19.00	38.00	57.00					4.00	8.00	12.00											19.00	38.00	57.00				4.00	8.00	8.00				19.00				19.00			0.63	0.13		0.63	0.13	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	008	0	1	01	01	H9003_008_0	9		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.66	0.33		0.66	0.33	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	01	01	H9003_008_0	9		N	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.66	0.33		0.66	0.33	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	008	0	1	01	01	H9003_008_0	9		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	80.00				47.00				47.00			1.56	1.33		1.56	1.33	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	01	01	H9003_008_0	9		N	Non-Preferred Brand	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	186.00				100.00				100.00			3.33	3.10		3.33	3.10	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	01	01	H9003_008_0	9		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											881.00	29	29	29				881.00	29	29	29										29	29	29				29	29	29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	01	01	H9003_008_0	9		N	Vaccines	4	10	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	008	0	1	01	01	H9003_008_0	9		N	Vaccines	4	10	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	009	0	1	01	01	H9003_009_0	9		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	01	01	H9003_009_0	9		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	009	0	1	01	01	H9003_009_0	9		N	Generic	4	11	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	01	01	H9003_009_0	9		N	Generic	4	11	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	009	0	1	01	01	H9003_009_0	9		N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	01	01	H9003_009_0	9		N	Non-Preferred Brand	4	11	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	01	01	H9003_009_0	9		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				863.00	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	01	01	H9003_009_0	9		N	Vaccines	4	10	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	009	0	1	01	01	H9003_009_0	9		N	Vaccines	4	10	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9042	001	1	1	04	01	H9042_001_1	5		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																	7.00			7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	1	1	04	01	H9042_001_1	5		N	Generic	4	11	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								14.00	28.00	42.00					8.00	16.00	24.00					8.00	16.00	0.00																	14.00			14.00			0.47	0.27	0.27			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	1	1	04	01	H9042_001_1	5		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	1	1	04	01	H9042_001_1	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	1	1	04	01	H9042_001_1	5		N	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31												31							31																								31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	2	1	04	01	H9042_001_2	4		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																	7.00			7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	2	1	04	01	H9042_001_2	4		N	Generic	4	11	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								14.00	28.00	42.00					8.00	16.00	24.00					8.00	16.00	0.00																	14.00			14.00			0.47	0.27	0.27			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	2	1	04	01	H9042_001_2	4		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								47.00	94.00	141.00					42.00	84.00	126.00					47.00	94.00	141.00																	47.00			47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	2	1	04	01	H9042_001_2	4		N	Non-Preferred Drug	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					10	31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9042	001	2	1	04	01	H9042_001_2	4		N	Specialty Tier	4	11	1	1	5	1		010	10			1				30												10	31												31							31																								31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					4.00	8.00	9.60					4.00	8.00	9.60																12.00				12.00			0.40	0.13	0.13			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	8		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.85	5.70	8.55					2.85	5.70	8.55																12.00				12.00			0.40	0.10	0.10			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9047	013	0	2	01	01	H9047_013_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	19.20	28.80					12.00	19.20	28.80																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	216.00					90.00	180.00	216.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											869.10	33						869.10	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	01	01	H9047_037_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	01	01	H9047_037_0	7		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	01	01	H9047_037_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	01	01	H9047_037_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	01	01	H9047_037_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											751.38	30						751.38	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					0.00	0.00	0.00																12.00				12.00			0.40	0.00	0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	7		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					45.00	90.00	90.00					45.00	90.00	90.00																47.00				47.00			1.57	1.50	1.50			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	180.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											749.89	30						749.89	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	8		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					3.00	3.00	3.00					3.00	3.00	3.00																14.00				14.00			0.47	0.10	0.10			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	8		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	12.00	12.00					12.00	12.00	12.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	70.50	94.00					47.00	70.50	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	200.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											763.97	29						763.97	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	045	0	1	01	01	H9047_045_0	5		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					4.00	8.00	8.00					4.00	8.00	8.00																14.00				14.00			0.47	0.13	0.13			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	045	0	1	01	01	H9047_045_0	5		N	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					13.00	20.80	31.20					13.00	20.80	31.20																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	045	0	1	01	01	H9047_045_0	5		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	106.00					47.00	94.00	106.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	045	0	1	01	01	H9047_045_0	5		N	Non-Preferred Drug	3	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	200.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	045	0	1	01	01	H9047_045_0	5		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											635.65	27						635.65	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	047	0	1	02	01	H9047_047_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					4.00	8.00	8.00					4.00	8.00	8.00																14.00				14.00			0.47	0.13	0.13			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	047	0	1	02	01	H9047_047_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					13.00	20.80	31.20					13.00	20.80	31.20																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	047	0	1	02	01	H9047_047_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	047	0	1	02	01	H9047_047_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	047	0	1	02	01	H9047_047_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											744.66	28						744.66	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	049	0	1	01	01	H9047_049_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	049	0	1	01	01	H9047_049_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	16.00	24.00					10.00	16.00	24.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	049	0	1	01	01	H9047_049_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	049	0	1	01	01	H9047_049_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	049	0	1	01	01	H9047_049_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											735.44	28						735.44	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	054	0	1	01	01	H9047_054_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	054	0	1	01	01	H9047_054_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	054	0	1	01	01	H9047_054_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	054	0	1	01	01	H9047_054_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	054	0	1	01	01	H9047_054_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											692.23	29						692.23	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	1	1	01	01	H9047_055_1	6		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					0.00	0.00	0.00																12.00				12.00			0.40	0.00	0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	1	1	01	01	H9047_055_1	6		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					0.00	0.00	0.00																12.00				12.00			0.40	0.00	0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9047	055	1	1	01	01	H9047_055_1	6		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	1	1	01	01	H9047_055_1	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					45.00	90.00	90.00					45.00	90.00	90.00																47.00				47.00			1.57	1.50	1.50			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	1	1	01	01	H9047_055_1	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	180.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	1	1	01	01	H9047_055_1	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											749.50	33						749.50	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	2	1	01	01	H9047_055_2	6		Y	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					0.00	0.00	0.00																12.00				12.00			0.40	0.00	0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	2	1	01	01	H9047_055_2	6		Y	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					0.00	0.00	0.00					0.00	0.00	0.00																12.00				12.00			0.40	0.00	0.00			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9047	055	2	1	01	01	H9047_055_2	6		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	2	1	01	01	H9047_055_2	6		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					45.00	90.00	90.00					45.00	90.00	90.00																47.00				47.00			1.57	1.50	1.50			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	2	1	01	01	H9047_055_2	6		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	180.00					90.00	180.00	180.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	055	2	1	01	01	H9047_055_2	6		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											749.50	33						749.50	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	1	1	02	01	H9047_056_1	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					4.00	8.00	8.00					4.00	8.00	8.00																14.00				14.00			0.47	0.13	0.13			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	1	1	02	01	H9047_056_1	7		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					13.00	20.80	31.20					13.00	20.80	31.20																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	1	1	02	01	H9047_056_1	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	1	1	02	01	H9047_056_1	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	1	1	02	01	H9047_056_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											746.33	28						746.33	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	2	1	02	01	H9047_056_2	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					4.00	8.00	8.00					4.00	8.00	8.00																14.00				14.00			0.47	0.13	0.13			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	2	1	02	01	H9047_056_2	7		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					13.00	20.80	31.20					13.00	20.80	31.20																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	2	1	02	01	H9047_056_2	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	112.80					47.00	94.00	112.80																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	2	1	02	01	H9047_056_2	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	240.00					100.00	200.00	240.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	056	2	1	02	01	H9047_056_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											746.33	28						746.33	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	059	0	1	02	01	H9047_059_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	059	0	1	02	01	H9047_059_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	059	0	1	02	01	H9047_059_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	059	0	1	02	01	H9047_059_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	059	0	1	02	01	H9047_059_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											791.90	30						791.90	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	060	0	1	02	01	H9047_060_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	060	0	1	02	01	H9047_060_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	060	0	1	02	01	H9047_060_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	060	0	1	02	01	H9047_060_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	060	0	1	02	01	H9047_060_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											786.65	30						786.65	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	062	0	1	02	01	H9047_062_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	062	0	1	02	01	H9047_062_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	062	0	1	02	01	H9047_062_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	062	0	1	02	01	H9047_062_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	062	0	1	02	01	H9047_062_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											765.26	30						765.26	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	063	0	1	01	01	H9047_063_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					0.00	0.00	0.00					0.00	0.00	0.00																16.00				16.00			0.53	0.00	0.00			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	063	0	1	01	01	H9047_063_0	6		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					10.00	10.00	10.00					10.00	10.00	10.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	063	0	1	01	01	H9047_063_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	063	0	1	01	01	H9047_063_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	063	0	1	01	01	H9047_063_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											750.60	29						750.60	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9065	001	0	1	01	01	H9065_001_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9065	001	0	1	01	01	H9065_001_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	001	0	1	01	01	H9065_001_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	002	0	1	02	01	H9065_002_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	6		N	Preferred Generic	4	01	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9065	002	0	1	02	01	H9065_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	002	0	1	02	01	H9065_002_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	003	0	1	02	01	H9065_003_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	003	0	1	02	01	H9065_003_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	004	0	1	02	01	H9065_004_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	004	0	1	02	01	H9065_004_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	005	0	1	01	01	H9065_005_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	005	0	1	01	01	H9065_005_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	005	0	1	01	01	H9065_005_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00	48.00	48.00																16.00				16.00			0.53	0.53	0.53			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	005	0	1	01	01	H9065_005_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	005	0	1	01	01	H9065_005_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	005	0	1	01	01	H9065_005_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	005	0	1	01	01	H9065_005_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	005	0	1	01	01	H9065_005_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	006	0	1	01	01	H9065_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	006	0	1	01	01	H9065_006_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00	48.00	48.00																16.00				16.00			0.53	0.53	0.53			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	006	0	1	01	01	H9065_006_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	007	0	1	01	01	H9065_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	007	0	1	01	01	H9065_007_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00	48.00	48.00																16.00				16.00			0.53	0.53	0.53			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					47.00	94.00	141.00					47.00	141.00	141.00																47.00				47.00			1.57	1.57	1.57			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	007	0	1	01	01	H9065_007_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9065	008	0	1	01	01	H9065_008_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					4.00	8.00	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9065	008	0	1	01	01	H9065_008_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9070	002	0	1	04	01	H9070_002_0	3		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					2.00		6.00											10.00		30.00				2.00		0.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_002_0	3		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_002_0	3		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_002_0	3		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	002	0	1	04	01	H9070_002_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		N	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	003	0	1	04	01	H9070_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	004	0	1	04	01	H9070_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	005	0	1	04	01	H9070_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	4		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	4		N	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	1	1	04	01	H9070_006_1	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		N	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	2	1	04	01	H9070_006_2	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		N	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9070	006	3	1	04	01	H9070_006_3	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	009	0	1	01	01	H9082_009_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	009	0	1	01	01	H9082_009_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	009	0	1	01	01	H9082_009_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.42			1.42			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	009	0	1	01	01	H9082_009_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				97.59	37	37	37																		37	37	37															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	009	0	1	01	01	H9082_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				529.11	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9096	001	0	1	02	01	H9096_001_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												30							30						30																		30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	001	0	1	02	01	H9096_001_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9096	002	0	1	02	01	H9096_002_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												31							31						31																		31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	002	0	1	02	01	H9096_002_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9096	004	0	1	01	01	H9096_004_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												28							28						28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	004	0	1	01	01	H9096_004_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9096	005	0	1	01	01	H9096_005_0	7		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	005	0	1	01	01	H9096_005_0	7		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9096	006	0	1	02	01	H9096_006_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												28							28						28																		28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	006	0	1	02	01	H9096_006_0	8		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9096	009	0	1	02	01	H9096_009_0	8		Y	Preferred Generic	4	01	1	2	1	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								7.00	14.00	7.00					0.00	0.00	0.00					7.00	14.00	7.00																	7.00			7.00			0.23	0.00	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	009	0	1	02	01	H9096_009_0	8		Y	Generic	4	01	1	2	2	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								12.00	24.00	24.00					5.00	10.00	10.00					12.00	24.00	24.00																	12.00			12.00			0.40	0.17	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	009	0	1	02	01	H9096_009_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								47.00	94.00	117.50					40.00	80.00	100.00					47.00	94.00	117.50																	47.00			47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	009	0	1	02	01	H9096_009_0	8		Y	Non-Preferred Brand	4	11	1	2	4	1		111	10	111		1				30	60	90	1	2	30	60	90					29	31								100.00	200.00	300.00					90.00	180.00	270.00					100.00	200.00	300.00																	100.00			100.00			3.33	3.00	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	009	0	1	02	01	H9096_009_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							29	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	009	0	1	02	01	H9096_009_0	8		Y	Vaccines	4	11	1	2	6	1		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9096	009	0	1	02	01	H9096_009_0	8		Y	Vaccines	4	11	1	2	6	3		010	10			1				30												29	31								0.00							0.00																										0.00			0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9104	006	0	1	01	01	H9104_006_0	8		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_0	8		N	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	100	1	2				30	60	100	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9104	006	0	1	01	01	H9104_006_0	8		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								12.00	24.00	36.00					5.00	10.00	15.00											12.00	24.00	36.00				5.00	10.00	0.00				12.00				12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_0	8		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_0	8		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	100	1	2				30	60	100	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_0	8		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9147	001	0	1	01	01	H9147_001_0	7		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00				7.00				7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	7		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					11.00	22.00	33.00											20.00	40.00	60.00				11.00	22.00	33.00				20.00				20.00			0.67	0.37		0.67	0.37	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	7		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	7		N	Non-Preferred Drug	3	11	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	7		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9147	001	0	1	01	01	H9147_001_0	7		N	Select Care Drugs	3	01	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9207	002	0	1	02	01	H9207_002_0	13	Y	N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	02	01	H9207_002_0	13	Y	N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	02	01	H9207_002_0	13	Y	N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	02	01	H9207_002_0	13	Y	N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	02	01	H9207_002_0	13	Y	N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				672.46	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	012	0	1	02	01	H9207_012_0	12	Y	N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	012	0	1	02	01	H9207_012_0	12	Y	N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	012	0	1	02	01	H9207_012_0	12	Y	N	Preferred Brand	4	10	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	012	0	1	02	01	H9207_012_0	12	Y	N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	012	0	1	02	01	H9207_012_0	12	Y	N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				881.76	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9219	001	0	1	04	01	H9219_001_0	7		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	001	0	1	04	01	H9219_001_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	001	0	1	04	01	H9219_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	001	0	1	04	01	H9219_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	001	0	1	04	01	H9219_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	001	0	1	04	01	H9219_001_0	7		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	001	0	1	04	01	H9219_001_0	7		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9219	002	0	1	04	01	H9219_002_0	6		N	Preferred Generic	4	01	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	002	0	1	04	01	H9219_002_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	002	0	1	04	01	H9219_002_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	002	0	1	04	01	H9219_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	002	0	1	04	01	H9219_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	002	0	1	04	01	H9219_002_0	6		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9219	002	0	1	04	01	H9219_002_0	6		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9258	001	0	1	01	01	H9258_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9258	001	0	1	01	01	H9258_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9258	001	0	1	01	01	H9258_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9258	001	0	1	01	01	H9258_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.69	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9258	001	0	1	01	01	H9258_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9276	021	0	1	01	01	H9276_021_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					5.00	10.00	15.00					5.00	10.00	15.00																20.00				20.00			0.67	0.17	0.17			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9276	021	0	1	01	01	H9276_021_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					0.00	0.00	0.00																10.00				10.00			0.33	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9302	003	0	1	01	01	H9302_003_0	8		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	0.00																12.00				12.00			0.40	0.07	0.07			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	8		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	24.00	36.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	8		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	8		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											68.14	33	33	33				68.14	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					2.00	4.00	6.00					2.00	4.00	0.00																12.00				12.00			0.40	0.07	0.07			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	24.00	36.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											73.85	33	33	33				73.85	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					3.00	6.00	9.00					3.00	6.00	0.00																12.00				12.00			0.40	0.10	0.10			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					12.00	24.00	36.00					12.00	24.00	36.00																20.00				20.00			0.67	0.40	0.40			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											72.49	33	33	33				72.49	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	7		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	001	0	1	01	01	H9335_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	001	0	1	01	01	H9335_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	001	0	1	01	01	H9335_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	001	0	1	01	01	H9335_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	001	0	1	01	01	H9335_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	002	0	1	01	01	H9335_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	002	0	1	01	01	H9335_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	002	0	1	01	01	H9335_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	002	0	1	01	01	H9335_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	002	0	1	01	01	H9335_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	003	0	1	01	01	H9335_003_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	003	0	1	01	01	H9335_003_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	14.00		42.00																									14.00		42.00				14.00		0.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	003	0	1	01	01	H9335_003_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	003	0	1	01	01	H9335_003_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.27	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	003	0	1	01	01	H9335_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	005	0	1	01	01	H9335_005_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	005	0	1	01	01	H9335_005_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	005	0	1	01	01	H9335_005_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	005	0	1	01	01	H9335_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	005	0	1	01	01	H9335_005_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	006	0	1	01	01	H9335_006_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	006	0	1	01	01	H9335_006_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	006	0	1	01	01	H9335_006_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	006	0	1	01	01	H9335_006_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.11	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9335	006	0	1	01	01	H9335_006_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_001_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_001_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_001_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.01	42		42																								42		42				42		42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	001	0	1	01	01	H9364_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.80	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	002	0	1	01	01	H9364_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	003	0	1	01	01	H9364_003_0	5		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	003	0	1	01	01	H9364_003_0	5		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	003	0	1	01	01	H9364_003_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	003	0	1	01	01	H9364_003_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.90	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9364	003	0	1	01	01	H9364_003_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9387	001	0	1	04	01	H9387_001_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	27.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	111.00																47.00				47.00			1.57	1.23	1.23			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					90.00	180.00	270.00					90.00	180.00	270.00																100.00				100.00			3.33	3.00	3.00			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9387	001	0	1	04	01	H9387_001_0	3		N	Select Care Drugs	4	11	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9403	003	0	1	01	01	H9403_003_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	2	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																0.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	003	0	1	01	01	H9403_003_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								20.00		50.00					15.00		37.50					15.00		37.50																15.00				15.00			0.67	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	003	0	1	01	01	H9403_003_0	8		Y	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	2	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	003	0	1	01	01	H9403_003_0	8		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01	110		1				30		90	2	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	003	0	1	01	01	H9403_003_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	2	2	30		90				30		31											1500.00	28		28				1500.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	8		Y	Preferred Generic	4	11	1	2	1	1		110	01	110		1				30		90	2	2	30		90				30		31								8.00		8.00					3.00		3.00					3.00		3.00																3.00				3.00			0.27	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	8		Y	Generic	4	11	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								17.00		42.50					12.00		30.00					12.00		30.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	2	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		90	2	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	8		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	2	2	30		90				30		31												33		33					33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9408	005	0	1	04	01	H9408_005_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	005	0	1	04	01	H9408_005_0	5		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	005	0	1	04	01	H9408_005_0	5		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	005	0	1	04	01	H9408_005_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	279.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	005	0	1	04	01	H9408_005_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											836.60	33						836.60	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	005	0	1	04	01	H9408_005_0	5		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	7		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	7		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	7		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	279.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	7		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1130.83	33						1130.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	1	1	04	01	H9408_006_1	7		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	7		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	7		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	7		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	7		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					93.00	186.00	279.00											100.00	200.00	300.00				93.00	186.00	279.00					100.00			100.00			3.33	3.10		3.33	3.10	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	7		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1130.83	33						1130.83	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9408	006	2	1	04	01	H9408_006_2	7		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9428	001	0	1	04	01	H9428_001_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	001	0	1	04	01	H9428_001_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H9428	001	0	1	04	01	H9428_001_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	001	0	1	04	01	H9428_001_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	001	0	1	04	01	H9428_001_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	001	0	1	04	01	H9428_001_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	002	0	1	04	01	H9428_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	002	0	1	04	01	H9428_002_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H9428	002	0	1	04	01	H9428_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		0.00				15.00				15.00		0.5				0.5	0.5	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	002	0	1	04	01	H9428_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	002	0	1	04	01	H9428_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9428	002	0	1	04	01	H9428_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9431	001	0	1	04	01	H9431_001_0	5		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	001	0	1	04	01	H9431_001_0	5		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	001	0	1	04	01	H9431_001_0	5		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	001	0	1	04	01	H9431_001_0	5		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	001	0	1	04	01	H9431_001_0	5		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	001	0	1	04	01	H9431_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	001	0	1	04	01	H9431_001_0	5		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											607.78	27						410.68	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	002	0	1	04	01	H9431_002_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	002	0	1	04	01	H9431_002_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	002	0	1	04	01	H9431_002_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	002	0	1	04	01	H9431_002_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	002	0	1	04	01	H9431_002_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	002	0	1	04	01	H9431_002_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	002	0	1	04	01	H9431_002_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											792.43	33						575.26	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	003	0	1	04	01	H9431_003_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	003	0	1	04	01	H9431_003_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	003	0	1	04	01	H9431_003_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	003	0	1	04	01	H9431_003_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	003	0	1	04	01	H9431_003_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	003	0	1	04	01	H9431_003_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	003	0	1	04	01	H9431_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											814.29	33						610.51	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	004	0	1	04	01	H9431_004_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	004	0	1	04	01	H9431_004_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	004	0	1	04	01	H9431_004_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	004	0	1	04	01	H9431_004_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	004	0	1	04	01	H9431_004_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	004	0	1	04	01	H9431_004_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	004	0	1	04	01	H9431_004_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											821.42	33						605.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	005	0	1	04	01	H9431_005_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	005	0	1	04	01	H9431_005_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	005	0	1	04	01	H9431_005_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	005	0	1	04	01	H9431_005_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	005	0	1	04	01	H9431_005_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	005	0	1	04	01	H9431_005_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	005	0	1	04	01	H9431_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											842.35	33						609.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	006	0	1	04	01	H9431_006_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	006	0	1	04	01	H9431_006_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	006	0	1	04	01	H9431_006_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	006	0	1	04	01	H9431_006_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	006	0	1	04	01	H9431_006_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	006	0	1	04	01	H9431_006_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	006	0	1	04	01	H9431_006_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											798.68	33						561.22	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	007	0	1	04	01	H9431_007_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	007	0	1	04	01	H9431_007_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	007	0	1	04	01	H9431_007_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	007	0	1	04	01	H9431_007_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	007	0	1	04	01	H9431_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	007	0	1	04	01	H9431_007_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	007	0	1	04	01	H9431_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											976.56	33						662.98	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	008	0	1	04	01	H9431_008_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	008	0	1	04	01	H9431_008_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	008	0	1	04	01	H9431_008_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	008	0	1	04	01	H9431_008_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	008	0	1	04	01	H9431_008_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	008	0	1	04	01	H9431_008_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	008	0	1	04	01	H9431_008_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											830.35	33						599.81	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	009	0	1	04	01	H9431_009_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	009	0	1	04	01	H9431_009_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	009	0	1	04	01	H9431_009_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	009	0	1	04	01	H9431_009_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	009	0	1	04	01	H9431_009_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	009	0	1	04	01	H9431_009_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	009	0	1	04	01	H9431_009_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											757.74	33						570.27	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	011	0	1	04	01	H9431_011_0	3		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	011	0	1	04	01	H9431_011_0	3		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	011	0	1	04	01	H9431_011_0	3		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	011	0	1	04	01	H9431_011_0	3		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	011	0	1	04	01	H9431_011_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	011	0	1	04	01	H9431_011_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	011	0	1	04	01	H9431_011_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											761.70	33						540.89	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	013	0	1	04	01	H9431_013_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	013	0	1	04	01	H9431_013_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	013	0	1	04	01	H9431_013_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	013	0	1	04	01	H9431_013_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	013	0	1	04	01	H9431_013_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	013	0	1	04	01	H9431_013_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	013	0	1	04	01	H9431_013_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											727.89	33						531.57	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	014	0	1	04	01	H9431_014_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	014	0	1	04	01	H9431_014_0	2		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	014	0	1	04	01	H9431_014_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	014	0	1	04	01	H9431_014_0	2		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	10.00											20.00	40.00	60.00				5.00	10.00	10.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9431	014	0	1	04	01	H9431_014_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	014	0	1	04	01	H9431_014_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9431	014	0	1	04	01	H9431_014_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											735.58	33						536.75	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
H9460	001	0	1	01	01	H9460_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	18.00					0.00	0.00	0.00											9.00	18.00	18.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	40.00					10.00	20.00	20.00											20.00	40.00	40.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											94.42	46	46	46				80.74	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											858.21	33						730.82	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9487	001	0	1	48	05	H9487_001_0	2			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9487	001	0	1	48	05	H9487_001_0	2			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9487	001	0	1	48	05	H9487_001_0	2			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9489	001	0	1	01	01	H9489_001_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					0.00	0.00	0.00					2.00	4.00	6.00																10.00				0.00			0.33	0.00	0.07			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9489	001	0	1	01	01	H9489_001_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	36.00	52.00					10.00	16.00	22.00					8.00	16.00	24.00																20.00				10.00			0.67	0.33	0.27			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9489	001	0	1	01	01	H9489_001_0	7		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	139.00					45.00	74.00	109.00					45.00	74.00	111.00																47.00				45.00			1.57	1.50	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9489	001	0	1	01	01	H9489_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	194.00	290.00					100.00	194.00	290.00					100.00	194.00	290.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9489	001	0	1	01	01	H9489_001_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											1.00	28						1.00	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9516	001	0	1	04	01	H9516_001_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	001	0	1	04	01	H9516_001_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	001	0	1	04	01	H9516_001_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	001	0	1	04	01	H9516_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	001	0	1	04	01	H9516_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				617.05	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	001	0	1	04	01	H9516_001_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	001	0	1	04	01	H9516_001_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9516	002	0	1	04	01	H9516_002_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	002	0	1	04	01	H9516_002_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	002	0	1	04	01	H9516_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	002	0	1	04	01	H9516_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	002	0	1	04	01	H9516_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				594.35	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	002	0	1	04	01	H9516_002_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9516	002	0	1	04	01	H9516_002_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9525	003	0	1	01	01	H9525_003_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	003	0	1	01	01	H9525_003_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								42.00	84.00	126.00					42.00	84.00	126.00					42.00	126.00	126.00																42.00				42.00			1.40	1.40	1.40			1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	004	0	1	01	01	H9525_004_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	006	0	1	01	01	H9525_006_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	007	0	1	01	01	H9525_007_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	007	0	1	01	01	H9525_007_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								4.00	8.00	12.00					4.00	8.00	12.00					4.00	12.00	12.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								33.00	66.00	99.00					33.00	66.00	99.00					33.00	99.00	99.00																33.00				33.00			1.10	1.10	1.10			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	285.00	285.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	007	0	1	01	01	H9525_007_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	008	0	1	01	01	H9525_008_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	008	0	1	01	01	H9525_008_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	008	0	1	01	01	H9525_008_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	008	0	1	01	01	H9525_008_0	5		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	190.00																100.00				100.00			3.33	3.17	3.17			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	008	0	1	01	01	H9525_008_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	008	0	1	01	01	H9525_008_0	5		N	Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	008	0	1	01	01	H9525_008_0	5		N	Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	001	1	1	04	01	H9572_001_1	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		0.00											7.00		21.00				1.00		0.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		0.00											18.00		54.00				10.00		0.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											73.00	48		48				63.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	1	1	04	01	H9572_001_1	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	001	2	1	04	01	H9572_001_2	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		0.00											7.00		21.00				1.00		0.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		0.00											18.00		54.00				10.00		0.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											73.00	48		48				63.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	2	1	04	01	H9572_001_2	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	001	3	1	04	01	H9572_001_3	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		0.00											7.00		21.00				1.00		0.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		0.00											18.00		54.00				10.00		0.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											73.00	48		48				63.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	3	1	04	01	H9572_001_3	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	001	4	1	04	01	H9572_001_4	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		0.00											7.00		21.00				1.00		0.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		0.00											18.00		54.00				10.00		0.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											73.00	48		48				63.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	4	1	04	01	H9572_001_4	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	001	6	1	04	01	H9572_001_6	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								7.00		21.00					1.00		0.00											7.00		21.00				1.00		0.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								18.00		54.00					10.00		0.00											18.00		54.00				10.00		0.00				18.00				18.00			0.58	0.32		0.58	0.32	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											73.00	48		48				63.00	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	001	6	1	04	01	H9572_001_6	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	002	1	1	04	01	H9572_002_1	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											98.00	50		50				91.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	1	1	04	01	H9572_002_1	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	002	2	1	04	01	H9572_002_2	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											98.00	50		50				91.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	2	1	04	01	H9572_002_2	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	002	3	1	04	01	H9572_002_3	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											98.00	50		50				91.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	3	1	04	01	H9572_002_3	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	002	4	1	04	01	H9572_002_4	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											98.00	50		50				91.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	4	1	04	01	H9572_002_4	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	002	6	1	04	01	H9572_002_6	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											98.00	50		50				91.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	6		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	002	6	1	04	01	H9572_002_6	6		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	003	1	1	04	01	H9572_003_1	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	45		45				72.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	1	1	04	01	H9572_003_1	7		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	003	2	1	04	01	H9572_003_2	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	45		45				72.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	2	1	04	01	H9572_003_2	7		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	003	3	1	04	01	H9572_003_3	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	45		45				72.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	3	1	04	01	H9572_003_3	7		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	003	4	1	04	01	H9572_003_4	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	45		45				72.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	4	1	04	01	H9572_003_4	7		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	003	6	1	04	01	H9572_003_6	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								12.00		36.00					7.00		0.00											12.00		36.00				7.00		0.00				12.00				12.00			0.39	0.23		0.39	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								42.00		126.00					37.00		111.00											42.00		126.00				37.00		111.00				42.00				42.00			1.35	1.19		1.35	1.19	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											69.00	45		45				72.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	003	6	1	04	01	H9572_003_6	7		N	Select Care Drugs	4	01	1	2	6	3		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9572	004	1	1	04	01	H9572_004_1	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											90.00	50		50				100.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	1	1	04	01	H9572_004_1	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											90.00	50		50				100.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	2	1	04	01	H9572_004_2	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											90.00	50		50				100.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	3	1	04	01	H9572_004_3	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											90.00	50		50				100.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	4	1	04	01	H9572_004_4	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	7		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								8.00		24.00					2.00		0.00											8.00		24.00				2.00		0.00				8.00				8.00			0.26	0.06		0.26	0.06	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	7		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								20.00		60.00					11.00		0.00											20.00		60.00				11.00		0.00				20.00				20.00			0.65	0.35		0.65	0.35	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	7		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.52	1.35		1.52	1.35	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	7		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											90.00	50		50				100.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	7		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	31						1.00	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9572	004	6	1	04	01	H9572_004_6	7		N	Select Care Drugs	4	01	1	2	6	1		110	01		110	1				31		90	1	2				31		90	31		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.16	0.00		0.16	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9576	001	0	1	48	05	H9576_001_0	4			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9576	001	0	1	48	05	H9576_001_0	4			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9576	001	0	1	48	05	H9576_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9589	003	0	1	04	01	H9589_003_0	13		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	2	2	30		90				30		31								5.00		5.00					0.00		0.00					0.00		0.00																0.00				0.00			0.17	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	13		Y	Generic	4	01	1	2	2	1		110	01	110		1				30		90	2	2	30		90				30		31								17.00		42.50					12.00		30.00					12.00		30.00																12.00				12.00			0.57	0.40	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	13		Y	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	2	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	13		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01	110		1				30		90	2	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	13		Y	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	2	2	30		90				30		31											1500.00	28		28				1500.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9615	007	0	1	04	01	H9615_007_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				98.08	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1022.32	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	7		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	7		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				99.25	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	008	0	1	04	01	H9615_008_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				764.19	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	009	0	1	04	01	H9615_009_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	009	0	1	04	01	H9615_009_0	6		N	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9615	009	0	1	04	01	H9615_009_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	009	0	1	04	01	H9615_009_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	009	0	1	04	01	H9615_009_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				97.92	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	009	0	1	04	01	H9615_009_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				1016.81	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	010	0	1	04	01	H9615_010_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	010	0	1	04	01	H9615_010_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	010	0	1	04	01	H9615_010_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	010	0	1	04	01	H9615_010_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				101.57	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	010	0	1	04	01	H9615_010_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				755.56	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	6		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	6		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	6		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				100.35	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	012	0	1	04	01	H9615_012_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				677.11	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	7		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	7		N	Generic	4	01	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	7		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	40.00		120.00																			40.00		80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	7		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				100.35	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	014	0	1	04	01	H9615_014_0	7		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				677.11	27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9630	001	0	1	01	01	H9630_001_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	001	0	1	01	01	H9630_001_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	002	0	1	01	01	H9630_002_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	003	0	1	01	01	H9630_003_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	004	0	1	01	01	H9630_004_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	005	0	1	01	01	H9630_005_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	006	0	1	01	01	H9630_006_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			0.00	0.00	0.00																8.00				8.00		0.27			0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	3		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9630	008	0	1	01	01	H9630_008_0	3		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								8.00	8.00	8.00					0.00	0.00	0.00					0.00	0.00	0.00																	8.00			0.00			0.27	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											929.00	33						929.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	001	0	1	01	01	H9686_001_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9686	002	0	1	01	01	H9686_002_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																	0.00			0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	002	0	1	01	01	H9686_002_0	3		N	Generic	4	01	1	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								20.00	40.00	60.00					14.00	28.00	42.00					14.00	28.00	42.00																	20.00			14.00			0.67	0.47	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	002	0	1	01	01	H9686_002_0	3		N	Preferred Brand	4	11	1	1	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											83.00	25	25	25				74.00	23	23	23				23	23	23																25		23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	002	0	1	01	01	H9686_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31											78.00	25	25	25				67.00	23	23	23				23	23	23																25		23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	002	0	1	01	01	H9686_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											640.00	25						640.00	25						25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	002	0	1	01	01	H9686_002_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	3		N	Preferred Generic	4	11	1	2	1	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								7.00	7.00	7.00					0.00	0.00	0.00					0.00	0.00	0.00																	7.00			0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	3		N	Generic	4	01	3	2	2	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								8.00	8.00	8.00					0.00	0.00	0.00					0.00	0.00	0.00																	8.00			0.00			0.27	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	3		N	Preferred Brand	4	11	1	2	3	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								47.00	87.00	127.00					40.00	80.00	120.00					40.00	80.00	120.00																	47.00			40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	3		N	Non-Preferred Drug	4	11	3	2	4	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								100.00	193.00	286.00					93.00	186.00	279.00					93.00	186.00	279.00																	100.00			93.00			3.33	3.10	3.10			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	3		N	Specialty Tier	4	11	1	1	5	1		010	10	010		1				30					30							10	31											929.00	33						929.00	33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	3		N	Select Care Drugs	4	01	1	2	6	1		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9686	003	0	1	01	01	H9686_003_0	3		N	Select Care Drugs	4	01	1	2	6	3		111	10	111		1				30	60	100	1	2	30	60	100					10	31								5.00	10.00	0.00					5.00	10.00	0.00					5.00	10.00	0.00																	5.00			5.00			0.17	0.17	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9699	004	1	1	01	01	H9699_004_1	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		100	1	2	30		100				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		100	1	2	30		100				30		31								20.00		40.00					13.00		26.00					13.00		26.00																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		100	1	2	30		100				30		31								47.00		94.00					40.00		80.00					40.00		80.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		100	1	2	30		100				30		31											98.58	47		47				87.53	45		45				45		45															47			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		100	1	2	30		100				30		31											1.00	28		28				1.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	6		N	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		100	1	2	30		100				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	1	1	01	01	H9699_004_1	6		N	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		100	1	2	30		100				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9699	004	2	1	01	01	H9699_004_2	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		100	1	2	30		100				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		100	1	2	30		100				30		31								20.00		40.00					13.00		26.00					13.00		26.00																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		100	1	2	30		100				30		31								47.00		94.00					40.00		80.00					40.00		80.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		100	1	2	30		100				30		31											98.58	47		47				87.53	45		45				45		45															47			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		100	1	2	30		100				30		31											1.00	28		28				1.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	6		N	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		100	1	2	30		100				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	2	1	01	01	H9699_004_2	6		N	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		100	1	2	30		100				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9699	004	3	1	01	01	H9699_004_3	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		100	1	2	30		100				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		100	1	2	30		100				30		31								20.00		40.00					13.00		26.00					13.00		26.00																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		100	1	2	30		100				30		31								47.00		94.00					40.00		80.00					40.00		80.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		100	1	2	30		100				30		31											98.58	47		47				87.53	45		45				45		45															47			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		100	1	2	30		100				30		31											1.00	28		28				1.00	28		28				28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	6		N	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				30		100	1	2	30		100				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	004	3	1	01	01	H9699_004_3	6		N	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				30		100	1	2	30		100				30		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9699	006	0	1	01	01	H9699_006_0	9		Y	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	3.00		6.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	9		Y	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		20.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	9		Y	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		94.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	9		Y	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				98.68	48		48																		48		48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	9		Y	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	28		28																		28		28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	9		Y	Select Care Drugs	4	01	3	2	6	1	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9699	006	0	1	01	01	H9699_006_0	9		Y	Select Care Drugs	4	01	3	2	6	3	110		01	110		1	30		100				1	2	30		100				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9706	001	0	1	01	01	H9706_001_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	001	0	1	01	01	H9706_001_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9706	001	0	1	01	01	H9706_001_0	7		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	001	0	1	01	01	H9706_001_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	001	0	1	01	01	H9706_001_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	001	0	1	01	01	H9706_001_0	7		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												29		29					29		29												29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	7		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	7		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		100	1	2						100	30		31								7.00		21.00					0.00		0.00													14.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9706	003	0	1	01	01	H9706_003_0	7		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								19.00		57.00					8.00		24.00													38.00						16.00				19.00				19.00			0.63	0.27				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	7		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					39.00		117.00													94.00						78.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	7		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					93.00		279.00													300.00						279.00				100.00				100.00			3.33	3.10				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9706	003	0	1	01	01	H9706_003_0	7		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												27		27					27		27												27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9712	001	0	1	48	05	H9712_001_0	4			Generic Drugs	4	01			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9712	001	0	1	48	05	H9712_001_0	4			Brand Drugs	4	10			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9725	001	0	1	01	01	H9725_001_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	20.00											15.00	30.00	45.00				10.00	20.00	0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											946.39	33						751.81	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	6		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								9.00	18.00	27.00					4.00	8.00	8.00											9.00	18.00	27.00				4.00	8.00	0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								40.00	80.00	120.00					35.00	70.00	105.00											40.00	80.00	120.00				35.00	70.00	105.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								100.00	200.00	300.00					95.00	190.00	285.00											100.00	200.00	300.00				95.00	190.00	285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	006	0	1	01	01	H9725_006_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											971.79	33						785.95	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	01	01	H9730_002_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	01	01	H9730_002_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H9730	002	0	1	01	01	H9730_002_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	01	01	H9730_002_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	01	01	H9730_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.01	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	01	01	H9730_002_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.4				1.4	1.4	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.93	43		43																								43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	12.00		36.00																									12.00		36.00				12.00		0.00				12.00				12.00		0.4				0.4	0.4	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				96.25	43		43																								43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	005	0	1	02	01	H9730_005_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	005	0	1	02	01	H9730_005_0	3		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H9730	005	0	1	02	01	H9730_005_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	005	0	1	02	01	H9730_005_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.5				1.5	1.5	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	005	0	1	02	01	H9730_005_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.09	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	005	0	1	02	01	H9730_005_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	007	0	1	01	01	H9730_007_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	007	0	1	01	01	H9730_007_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	007	0	1	01	01	H9730_007_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	007	0	1	01	01	H9730_007_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.10	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	007	0	1	01	01	H9730_007_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	009	0	1	01	01	H9730_009_0	4		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	009	0	1	01	01	H9730_009_0	4		N	Preferred Generic	4	11	3	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	3
H9730	009	0	1	01	01	H9730_009_0	4		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	009	0	1	01	01	H9730_009_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	009	0	1	01	01	H9730_009_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.29	43		43																								43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	009	0	1	01	01	H9730_009_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	010	0	1	01	01	H9730_010_0	3		N	Preferred Generic	4	11	3	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	010	0	1	01	01	H9730_010_0	3		N	Generic	4	11	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		0.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	010	0	1	01	01	H9730_010_0	3		N	Preferred Brand	4	11	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	010	0	1	01	01	H9730_010_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.33	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	010	0	1	01	01	H9730_010_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5.00	10.00	10.00																			5.00	10.00	10.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8		N	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	5.00	10.00	10.00																			5.00	10.00	10.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9808	004	0	1	04	01	H9808_004_0	8		N	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90.00	180.00	180.00																			90.00	180.00	180.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8		N	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				946.71	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	8		N	Preferred Generic	4	01	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	8		N	Preferred Generic	4	01	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9808	005	0	1	04	01	H9808_005_0	8		N	Generic	4	11	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12.00	24.00	24.00																			12.00	24.00	24.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	8		N	Preferred Brand	4	11	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	8		N	Non-Preferred Drug	4	11	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	80.00	160.00	160.00																			80.00	160.00	160.00																	80.00			80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	8		N	Specialty Tier	4	11	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1109.21	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	001	0	1	01	01	H9811_001_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9811	001	0	1	01	01	H9811_001_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	5		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9811	005	0	1	01	01	H9811_005_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_0	4		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9811	005	0	1	01	01	H9811_005_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	126.00																			42.00	84.00	126.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	005	0	1	01	01	H9811_005_0	4		N	Select Care Drugs	4	11	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9811	006	0	1	01	01	H9811_006_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	006	0	1	01	01	H9811_006_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	006	0	1	01	01	H9811_006_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	006	0	1	01	01	H9811_006_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				96.23	48	48	48																		48	48	48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	006	0	1	01	01	H9811_006_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	007	0	1	01	01	H9811_007_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	007	0	1	01	01	H9811_007_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	007	0	1	01	01	H9811_007_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	007	0	1	01	01	H9811_007_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.46	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	007	0	1	01	01	H9811_007_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	008	0	1	01	01	H9811_008_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	4		N	Non-Preferred Drug	4	11	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	008	0	1	01	01	H9811_008_0	4		N	Select Care Drugs	4	11	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9811	009	0	1	01	01	H9811_009_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	009	0	1	01	01	H9811_009_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	009	0	1	01	01	H9811_009_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	009	0	1	01	01	H9811_009_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				89.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	009	0	1	01	01	H9811_009_0	3		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				0.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				88.70	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	6		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	6		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				91.25	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	006	0	1	01	01	H9834_006_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	006	0	1	01	01	H9834_006_0	5		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	006	0	1	01	01	H9834_006_0	5		N	Preferred Brand	4	10	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	006	0	1	01	01	H9834_006_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				93.42	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	006	0	1	01	01	H9834_006_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31					30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	001	0	1	01	01	H9861_001_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		18.00					2.00		0.00					2.00		0.00																6.00				6.00			0.20	0.07	0.07			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	001	0	1	01	01	H9861_001_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	001	0	1	01	01	H9861_001_0	8		Y	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					47.00		141.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	001	0	1	01	01	H9861_001_0	8		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					100.00		300.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	001	0	1	01	01	H9861_001_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											603.50	30						603.50	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								6.00		18.00					2.00		0.00					2.00		0.00																6.00				6.00			0.20	0.07	0.07			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					10.00		30.00					10.00		30.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	8		Y	Preferred Brand	4	10	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					47.00		141.00					47.00		141.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	8		Y	Non-Preferred Drug	4	10	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		300.00					100.00		300.00					100.00		300.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9861	002	0	1	01	01	H9861_002_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											617.67	33						617.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9869	001	0	1	48	05	H9869_001_0	4			Generic Drugs	4	01			1	1	110		01	101		1	30		90				1	1		60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9869	001	0	1	48	05	H9869_001_0	4			Brand Drugs	4	10			2	1	110		01	101		1	30		90				1	1		60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9869	001	0	1	48	05	H9869_001_0	4			Non-Medicare Rx/OTC Drugs	4	11			3	1	110		01	101		1	30		90				1	1		60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9878	001	0	1	04	01	H9878_001_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	001	0	1	04	01	H9878_001_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	001	0	1	04	01	H9878_001_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	001	0	1	04	01	H9878_001_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	001	0	1	04	01	H9878_001_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				715.17	32																				32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	001	0	1	04	01	H9878_001_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	001	0	1	04	01	H9878_001_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9878	002	0	1	04	01	H9878_002_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	002	0	1	04	01	H9878_002_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	002	0	1	04	01	H9878_002_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	002	0	1	04	01	H9878_002_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	002	0	1	04	01	H9878_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				593.17	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	002	0	1	04	01	H9878_002_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	002	0	1	04	01	H9878_002_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9878	003	0	1	04	01	H9878_003_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	003	0	1	04	01	H9878_003_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	003	0	1	04	01	H9878_003_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	003	0	1	04	01	H9878_003_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	003	0	1	04	01	H9878_003_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				608.27	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	003	0	1	04	01	H9878_003_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	003	0	1	04	01	H9878_003_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9878	006	0	1	04	01	H9878_006_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	006	0	1	04	01	H9878_006_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	006	0	1	04	01	H9878_006_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	006	0	1	04	01	H9878_006_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	006	0	1	04	01	H9878_006_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				603.81	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	006	0	1	04	01	H9878_006_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	006	0	1	04	01	H9878_006_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9878	008	0	1	04	01	H9878_008_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	008	0	1	04	01	H9878_008_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	008	0	1	04	01	H9878_008_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	008	0	1	04	01	H9878_008_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	008	0	1	04	01	H9878_008_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				597.48	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	008	0	1	04	01	H9878_008_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	008	0	1	04	01	H9878_008_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9878	009	0	1	04	01	H9878_009_0	5		N	Preferred Generic	4	11	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	009	0	1	04	01	H9878_009_0	5		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	009	0	1	04	01	H9878_009_0	5		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		94.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	009	0	1	04	01	H9878_009_0	5		N	Non-Preferred Drug	4	11	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	009	0	1	04	01	H9878_009_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				609.33	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	009	0	1	04	01	H9878_009_0	5		N	Select Care Drugs	4	11	3	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9878	009	0	1	04	01	H9878_009_0	5		N	Select Care Drugs	4	11	3	2	6	3	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		3
H9917	001	0	1	01	01	H9917_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2.00	4.00	6.00																																						2.00			2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	001	0	1	01	01	H9917_001_0	4		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	001	0	1	01	01	H9917_001_0	4		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	001	0	1	01	01	H9917_001_0	4		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	001	0	1	01	01	H9917_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				800.78	25																																						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	5		Y	Preferred Generic	4	01	1	2	1	1	111		10			1	30	60	90				1	2								10	31	2.00	4.00	6.00																																						2.00			2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	5		Y	Generic	4	01	1	2	2	1	111		10			1	30	60	90				1	2								10	31	15.00	30.00	45.00																																						15.00			15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	5		Y	Preferred Brand	4	10	1	2	3	1	111		10			1	30	60	90				1	2								10	31	45.00	90.00	135.00																																						45.00			45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	5		Y	Non-Preferred Brand	4	10	1	2	4	1	111		10			1	30	60	90				1	2								10	31	95.00	190.00	285.00																																						95.00			95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9917	002	0	1	01	01	H9917_002_0	5		Y	Specialty Tier	4	11	1	1	5	1	010		10			1	30															10	31				855.70	25																																						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	4		N	Preferred Generic	4	11	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	4		N	Generic	4	11	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.42			1.42			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				99.03	34	34	34																		34	34	34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9955	001	0	1	01	01	H9955_001_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	31								31						31		31				435.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0110	003	0	1	31	11	R0110_003_0	4			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						28.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		42.00																											42.00						28.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R0759	001	0	1	31	11	R0759_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0759	001	0	1	31	11	R0759_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				275.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	10		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					2.00	4.00	6.00					2.00	4.00	0.00																4.00				4.00			0.13	0.07	0.07			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	10		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					10.00	20.00	20.00																18.00				18.00			0.60	0.33	0.33			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	10		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	10		Y	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	237.50																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0802	001	0	1	31	11	R0802_001_0	10		Y	Specialty Tier	4	10	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	28	28	28				600.00	28	28	28				28	28	28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0865	003	0	1	31	11	R0865_003_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R0923	002	0	1	31	11	R0923_002_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	2			Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	2			Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	2			Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	2			Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1390	002	0	1	31	11	R1390_002_0	2			Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	2			Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	2			Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	2			Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	2			Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R1532	002	0	1	31	11	R1532_002_0	2			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		10.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	14.00		35.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	14.00		35.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R2604	001	0	1	31	11	R2604_001_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	001	0	1	31	11	R2604_001_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				241.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		8.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R2604	003	0	1	31	11	R2604_003_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R2604	003	0	1	31	11	R2604_003_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				355.00	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	8		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8		Y	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
R3332	001	0	1	31	11	R3332_001_0	8		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	2	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											1020.16	28						1020.16	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8		Y	Select Care Drugs	4	01	1	2	6	1		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R3332	001	0	1	31	11	R3332_001_0	8		Y	Select Care Drugs	4	01	1	2	6	3		110	01	110		1				31		90	1	2	31		90				31		31								0.00		0.00					0.00		0.00					0.00		0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
R3392	002	0	1	31	11	R3392_002_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3392	002	0	1	31	11	R3392_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		10.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	15.00		37.50																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	15.00		37.50																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R3444	009	0	1	31	11	R3444_009_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				281.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		10.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	15.00		37.50																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	15.00		37.50																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R3444	012	0	1	31	11	R3444_012_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				342.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	023	0	1	31	11	R3444_023_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		10.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	023	0	1	31	11	R3444_023_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	15.00		37.50																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	023	0	1	31	11	R3444_023_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	15.00		37.50																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R3444	023	0	1	31	11	R3444_023_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	023	0	1	31	11	R3444_023_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	023	0	1	31	11	R3444_023_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				341.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	2			Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	2			Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	2			Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	2			Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3887	002	0	1	31	11	R3887_002_0	2			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	003	0	1	31	11	R4182_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4182	004	0	1	31	11	R4182_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4487	001	0	1	31	11	R4487_001_0	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					6.00	12.00	18.00					6.00	12.00	12.00																11.00				11.00			0.37	0.20	0.20			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					37.00	74.00	111.00					37.00	74.00	74.00																47.00				47.00			1.57	1.23	1.23			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	5			Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											71.36	47	47	47				69.84	46	46	46				46	46	46															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R4487	001	0	1	31	11	R4487_001_0	5			Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
R4845	002	0	1	31	11	R4845_002_0	2			Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_002_0	2			Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					12.00		36.00											20.00		60.00				12.00		0.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_002_0	2			Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_002_0	2			Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R4845	002	0	1	31	11	R4845_002_0	2			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R5329	001	0	1	31	11	R5329_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				227.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R5342	001	0	1	31	11	R5342_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				270.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R5342	005	0	1	31	11	R5342_005_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				340.00	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R5342	006	0	1	31	11	R5342_006_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				273.00	30																										30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	2			Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		0.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	2			Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					9.00		27.00											20.00		60.00				9.00		0.00				20.00				20.00			0.67	0.30		0.67	0.30	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	2			Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	2			Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5361	002	0	1	31	11	R5361_002_0	2			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	2			Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								16.00		48.00					16.00		48.00											16.00		48.00				16.00		0.00				16.00				16.00			0.53	0.53		0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	2			Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	2			Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	2			Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5495	002	0	1	31	11	R5495_002_0	2			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		N	Preferred Generic	4	11	3	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		N	Non-Preferred Drug	4	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5941	014	0	1	31	11	R5941_014_0	5			Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					6.00	12.00	18.00					0.00	0.00	0.00																11.00				11.00			0.37	0.20	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	5			Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	30.00	30.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	5			Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	84.00																47.00				47.00			1.57	1.40	1.40			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	5			Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											69.22	42	42	42				67.57	41	41	41				41	41	41															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	5			Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	5			Select Care Drugs	4	01	1	2	6	1		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	014	0	1	31	11	R5941_014_0	5			Select Care Drugs	4	01	1	2	6	3		111	01	111		1				30	60	100	1	2	30	60	100				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
R6694	003	0	1	31	11	R6694_003_0	4			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	003	0	1	31	11	R6694_003_0	4			Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6694	003	0	1	31	11	R6694_003_0	4			Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	003	0	1	31	11	R6694_003_0	4			Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					0.00	0.00	0.00											20.00	40.00	60.00				0.00	0.00	0.00					20.00			20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6694	003	0	1	31	11	R6694_003_0	4			Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	003	0	1	31	11	R6694_003_0	4			Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	003	0	1	31	11	R6694_003_0	4			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											708.01	33						558.97	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	005	0	1	31	11	R6694_005_0	2			Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	005	0	1	31	11	R6694_005_0	2			Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	005	0	1	31	11	R6694_005_0	2			Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	005	0	1	31	11	R6694_005_0	2			Non-Preferred Drug	3	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	005	0	1	31	11	R6694_005_0	2			Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											643.27	29						480.61	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	006	0	1	31	11	R6694_006_0	2			Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	006	0	1	31	11	R6694_006_0	2			Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					0.00	0.00	0.00											15.00	30.00	45.00				0.00	0.00	0.00					15.00			15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6694	006	0	1	31	11	R6694_006_0	2			Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	006	0	1	31	11	R6694_006_0	2			Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	25.00											20.00	40.00	60.00				10.00	20.00	25.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6694	006	0	1	31	11	R6694_006_0	2			Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	006	0	1	31	11	R6694_006_0	2			Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6694	006	0	1	31	11	R6694_006_0	2			Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											714.68	31						539.42	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
R6801	009	0	1	31	11	R6801_009_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R6801	009	0	1	31	11	R6801_009_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				287.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R6801	012	0	1	31	11	R6801_012_0	4		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				241.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	8			Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					7.00		21.00											19.00		57.00				7.00		0.00				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	8			Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	8			Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	8			Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7220	002	0	1	31	11	R7220_002_0	8			Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	2		N	Preferred Generic	3	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	2		N	Generic	3	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	2		N	Preferred Brand	3	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	2		N	Non-Preferred Drug	3	11	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7315	002	0	1	31	11	R7315_002_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Preferred Generic	4	01	1	2	1	1	110		01		100	1	30		90				2	2						90	30		31	3.00		6.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Generic	4	01	3	2	2	1	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Generic	4	01	3	2	2	3	110		01		100	1	30		90				2	2						90	30		31	12.00		24.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
R7444	001	0	1	31	11	R7444_001_0	3		Y	Preferred Brand	4	11	1	2	3	1	110		01		100	1	30		90				2	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1	110		01		100	1	30		90				2	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	3		Y	Specialty Tier	4	11	1	1	5	1	010		01		010	1	30											30			30		31				321.00	27																										27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					2.00		4.00					2.00		4.00																9.00				9.00			0.30	0.06	0.06			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								17.00		51.00					10.00		20.00					10.00		20.00																17.00				17.00			0.56	0.33	0.33			0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		80.00					40.00		80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											87.00	50		50				80.00	45		45				45		45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1		N	Preferred Generic	2	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	1.00		3.00																			1.00		2.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1		N	Generic	2	01	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1		N	Preferred Brand	2	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	46.00		138.00																			46.00		92.00																46.00				46.00		1.53			1.53			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1		N	Non-Preferred Drug	2	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				98.00	48		48																		48		48															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	1		N	Specialty Tier	2	11	1	1	5	1	110		01	110		1	30		90				1	2	30		90				30		31				98.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	3		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								9.00		27.00					2.00		4.00					2.00		4.00																9.00				9.00			0.30	0.06	0.06			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	3		N	Generic	4	01	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					8.00		16.00					8.00		16.00																15.00				15.00			0.50	0.26	0.26			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	3		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					40.00		80.00					40.00		80.00																47.00				47.00			1.56	1.33	1.33			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											84.00	50		50				81.00	45		45				45		45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	010	0		29	10	S1030_010_0	3		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	3		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								2.00	4.00	6.00					0.00	0.00	0.00											2.00	2.00	2.00				0.00	0.00	0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	3		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					4.00	8.00	12.00											8.00	8.00	8.00				4.00	4.00	4.00				8.00				8.00			0.27	0.13		0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	3		N	Preferred Brand	3	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											31.00	25	25	25				31.00	10	10	10										25	25	25				10	10	10			10			10								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.00	25	25	25				68.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1894	001	0		29	10	S1894_001_0	3		N	Specialty Tier	3	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											963.00	25	25	25				963.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4		N	Preferred Generic	3	01	1	2	1	1		111	01	100		1				30	60	90	2	2			90				30		31								8.00	16.00	24.00					2.00	4.00	4.00							4.00																8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4		N	Generic	3	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								15.00	30.00	45.00					6.00	12.00	12.00							12.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								44.00	88.00	132.00					39.00	78.00	78.00							78.00																44.00				44.00			1.47	1.30				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											97.90	44	44	44				91.23	41	41	41						41															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											832.52	25						832.52	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	100		1				30	60	90	2	2			90				30		31								11.00	22.00	33.00					2.00	4.00	4.00							4.00																11.00				11.00			0.37	0.07				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3		N	Generic	4	01	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								14.00	28.00	42.00					7.00	14.00	14.00							14.00																14.00				14.00			0.47	0.23				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					43.00	86.00	86.00							86.00																47.00				47.00			1.57	1.43				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											97.49	35	35	35				91.92	33	33	33						33															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31											946.44	33						946.44	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	4		N	Preferred Generic	2	11	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	4		N	Generic	2	11	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	4		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	4		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				38.90	44	44	44																		44	44	44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	4		N	Specialty Tier	2	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				928.31	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	4		Y	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					1.00	2.00	3.00					1.00	2.00	3.00																10.00				10.00			0.33	0.03	0.03			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	4		Y	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					6.00	12.00	18.00					6.00	12.00	18.00																15.00				15.00			0.50	0.20	0.20			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	4		Y	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					35.00	70.00	105.00					35.00	70.00	105.00																47.00				47.00			1.57	1.17	1.17			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											35.82	50	50	50				23.81	37	37	37				37	37	37															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	4		Y	Specialty Tier	4	11	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											835.40	33	33	33				788.97	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	5		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											61.00	50		50				60.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	24		24				23.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	38		38				59.00	35		35										38		38				35		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4		N	Preferred Generic	3	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4		N	Generic	3	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					6.00	12.00	18.00					6.00	12.00	12.00																20.00				20.00			0.67	0.20	0.20			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					36.00	72.00	108.00					36.00	72.00	72.00																47.00				47.00			1.57	1.20	1.20			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											99.51	50	50	50				76.61	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5		N	Preferred Generic	4	11	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5		N	Preferred Generic	4	11	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	1.00	1.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S2893	003	0		29	10	S2893_003_0	5		N	Generic	4	11	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5		N	Generic	4	11	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S2893	003	0		29	10	S2893_003_0	5		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								40.00	80.00	120.00					30.00	60.00	90.00					30.00	60.00	60.00																40.00				40.00			1.33	1.00	1.00			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											85.26	45	45	45				73.51	35	35	35				35	35	35															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								41.00	82.00	123.00					34.00	68.00	102.00					34.00	68.00	102.00																41.00				41.00			1.37	1.13	1.13			1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											100.78	34	34	34				94.85	32	32	32				32	32	32															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	001	0		29	10	S3375_001_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											77.00	50	50	50				69.30	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	002	0		29	10	S3375_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	003	0		29	10	S3375_003_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	003	0		29	10	S3375_003_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S3375	003	0		29	10	S3375_003_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					3.00	6.00	9.00					3.00	6.00	9.00																7.00				7.00			0.23	0.10	0.10			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	003	0		29	10	S3375_003_0	4		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					3.00	6.00	9.00					3.00	6.00	9.00																7.00				7.00			0.23	0.10	0.10			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S3375	003	0		29	10	S3375_003_0	4		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											24.77	22	22	22				22.52	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	003	0		29	10	S3375_003_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											88.51	42	42	42				82.18	39	39	39				39	39	39															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3375	003	0		29	10	S3375_003_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	005	0		29	10	S3535_005_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01			1				30	60	90	2	2							30		31								15.00	30.00	45.00					3.00	6.00	9.00																							15.00				15.00			0.50	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	005	0		29	10	S3535_005_0	1		N	Generic	4	01	1	2	2	1		111	01			1				30	60	90	2	2							30		31								20.00	40.00	60.00					5.00	10.00	15.00																							20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	005	0		29	10	S3535_005_0	1		N	Preferred Brand	4	10	1	2	3	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	005	0		29	10	S3535_005_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01			1				30	60	90	2	2							30		31											52.06	50	50	50				47.82	50	50	50																					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	005	0		29	10	S3535_005_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	006	0		29	10	S3535_006_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01			1				30	60	90	2	2							30		31								15.00	30.00	45.00					3.00	6.00	9.00																							15.00				15.00			0.50	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	006	0		29	10	S3535_006_0	1		N	Generic	4	01	1	2	2	1		111	01			1				30	60	90	2	2							30		31								20.00	40.00	60.00					5.00	10.00	15.00																							20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	006	0		29	10	S3535_006_0	1		N	Preferred Brand	4	10	1	2	3	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	006	0		29	10	S3535_006_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01			1				30	60	90	2	2							30		31											52.16	50	50	50				47.91	50	50	50																					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	006	0		29	10	S3535_006_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	007	0		29	10	S3535_007_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01			1				30	60	90	2	2							30		31								15.00	30.00	45.00					3.00	6.00	9.00																							15.00				15.00			0.50	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	007	0		29	10	S3535_007_0	1		N	Generic	4	01	1	2	2	1		111	01			1				30	60	90	2	2							30		31								20.00	40.00	60.00					5.00	10.00	15.00																							20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	007	0		29	10	S3535_007_0	1		N	Preferred Brand	4	10	1	2	3	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	007	0		29	10	S3535_007_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01			1				30	60	90	2	2							30		31											49.32	50	50	50				45.31	50	50	50																					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	007	0		29	10	S3535_007_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	008	0		29	10	S3535_008_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01			1				30	60	90	2	2							30		31								15.00	30.00	45.00					3.00	6.00	9.00																							15.00				15.00			0.50	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	008	0		29	10	S3535_008_0	1		N	Generic	4	01	1	2	2	1		111	01			1				30	60	90	2	2							30		31								20.00	40.00	60.00					5.00	10.00	15.00																							20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	008	0		29	10	S3535_008_0	1		N	Preferred Brand	4	10	1	2	3	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	008	0		29	10	S3535_008_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01			1				30	60	90	2	2							30		31											49.75	50	50	50				45.68	50	50	50																					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	008	0		29	10	S3535_008_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	009	0		29	10	S3535_009_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01			1				30	60	90	2	2							30		31								4.00	8.00	12.00					0.00	0.00	0.00																							4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	009	0		29	10	S3535_009_0	1		N	Generic	2	01	1	2	2	1		111	01			1				30	60	90	2	2							30		31								11.00	22.00	33.00					10.00	20.00	30.00																							11.00				11.00			0.37	0.33				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	009	0		29	10	S3535_009_0	1		N	Preferred Brand	2	10	1	2	3	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	009	0		29	10	S3535_009_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01			1				30	60	90	2	2							30		31											79.91	50	50	50				70.83	50	50	50																					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	009	0		29	10	S3535_009_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											1.00	25						1.00	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	010	0		29	10	S3535_010_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01			1				30	60	90	2	2							30		31								3.00	6.00	9.00					0.00	0.00	0.00																							3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	010	0		29	10	S3535_010_0	1		N	Generic	2	01	1	2	2	1		111	01			1				30	60	90	2	2							30		31								11.00	22.00	33.00					10.00	20.00	30.00																							11.00				11.00			0.37	0.33				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	010	0		29	10	S3535_010_0	1		N	Preferred Brand	2	10	1	2	3	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	010	0		29	10	S3535_010_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01			1				30	60	90	2	2							30		31											80.40	50	50	50				71.08	50	50	50																					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	010	0		29	10	S3535_010_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											1.00	25						1.00	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	011	0		29	10	S3535_011_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01			1				30	60	90	2	2							30		31								2.00	4.00	6.00					0.00	0.00	0.00																							2.00				2.00			0.07	0.00				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	011	0		29	10	S3535_011_0	1		N	Generic	2	01	1	2	2	1		111	01			1				30	60	90	2	2							30		31								11.00	22.00	33.00					10.00	20.00	30.00																							11.00				11.00			0.37	0.33				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	011	0		29	10	S3535_011_0	1		N	Preferred Brand	2	10	1	2	3	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	011	0		29	10	S3535_011_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01			1				30	60	90	2	2							30		31											77.02	50	50	50				68.15	50	50	50																					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	011	0		29	10	S3535_011_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											1.00	25						1.00	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	012	0		29	10	S3535_012_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01			1				30	60	90	2	2							30		31								2.00	4.00	6.00					0.00	0.00	0.00																							2.00				2.00			0.07	0.00				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	012	0		29	10	S3535_012_0	1		N	Generic	2	01	1	2	2	1		111	01			1				30	60	90	2	2							30		31								12.00	24.00	36.00					10.00	20.00	30.00																							12.00				12.00			0.40	0.33				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	012	0		29	10	S3535_012_0	1		N	Preferred Brand	2	10	1	2	3	1		111	01			1				30	60	90	2	2							30		31								47.00	94.00	141.00					47.00	94.00	141.00																							47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	012	0		29	10	S3535_012_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01			1				30	60	90	2	2							30		31											78.33	50	50	50				69.46	50	50	50																					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S3535	012	0		29	10	S3535_012_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01			1				30											30		31											1.00	25						1.00	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		5.00				5.00				5.00			0.17	0.07		0.17	0.07	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								33.00		99.00					29.00		87.00											33.00		99.00				29.00		72.50				33.00				33.00			1.1	0.97		1.1	0.97	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											85.87	40		40				72.99	34		34										40		40				34		34			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		2.50				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								42.00		126.00					35.00		105.00											42.00		126.00				35.00		87.50				42.00				42.00			1.4	1.17		1.4	1.17	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											90.77	45		45				70.6	35		35										45		45				35		35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		7.50				10.00				10.00			0.33	0.1		0.33	0.1	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								37.00		111.00					30.00		90.00											37.00		111.00				30.00		75.00				37.00				37.00			1.23	1.00		1.23	1.00	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.49	41		41				71.23	33		33										41		41				33		33			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		2.50				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								35.00		105.00					25.00		75.00											35.00		105.00				25.00		62.50				35.00				35.00			1.17	0.83		1.17	0.83	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.69	42		42				65.75	33		33										42		42				33		33			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		5.00				4.00				4.00			0.13	0.07		0.13	0.07	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		75.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.62	40		40				75.58	33		33										40		40				33		33			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					3.00		9.00											9.00		27.00				3.00		7.50				9.00				9.00			0.3	0.1		0.3	0.1	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		75.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.17	41		41				72.29	34		34										41		41				34		34			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					3.00		9.00											9.00		27.00				3.00		7.50				9.00				9.00			0.3	0.1		0.3	0.1	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					30.00		90.00											40.00		120.00				30.00		75.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.52	46		46				59.2	33		33										46		46				33		33			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					2.00		6.00											8.00		24.00				2.00		5.00				8.00				8.00			0.27	0.07		0.27	0.07	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								36.00		108.00					30.00		90.00											36.00		108.00				30.00		75.00				36.00				36.00			1.2	1.00		1.2	1.00	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.54	40		40				73.55	34		34										40		40				34		34			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		2.50				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					30.00		90.00											40.00		120.00				30.00		75.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											90.97	38		38				81.4	34		34										38		38				34		34			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		2.50				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					30.00		90.00											40.00		120.00				30.00		75.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.74	41		41				68.21	33		33										41		41				33		33			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					4.00		12.00											7.00		21.00				4.00		10.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								41.00		123.00					32.00		96.00											41.00		123.00				32.00		80.00				41.00				41.00			1.37	1.07		1.37	1.07	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.28	42		42				69.84	34		34										42		42				34		34			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		5.00				6.00				6.00			0.2	0.07		0.2	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					30.00		90.00											40.00		120.00				30.00		75.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.07	42		42				68.41	33		33										42		42				33		33			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		5.00				6.00				6.00			0.2	0.07		0.2	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		75.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.84	44		44				68.65	34		34										44		44				34		34			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					4.00		12.00											7.00		21.00				4.00		10.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								36.00		108.00					30.00		90.00											36.00		108.00				30.00		75.00				36.00				36.00			1.2	1.00		1.2	1.00	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											92.19	43		43				70.75	33		33										43		43				33		33			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		75.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											81.88	43		43				64.74	34		34										43		43				34		34			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					4.00		12.00											8.00		24.00				4.00		10.00				8.00				8.00			0.27	0.13		0.27	0.13	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					32.00		96.00											40.00		120.00				32.00		80.00				40.00				40.00			1.33	1.07		1.33	1.07	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.22	45		45				64.69	33		33										45		45				33		33			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								38.00		114.00					33.00		99.00											38.00		114.00				33.00		82.50				38.00				38.00			1.27	1.1		1.27	1.1	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.38	45		45				63	34		34										45		45				34		34			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								38.00		114.00					30.00		90.00											38.00		114.00				30.00		75.00				38.00				38.00			1.27	1.00		1.27	1.00	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.52	42		42				72.93	35		35										42		42				35		35			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		5.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								37.00		111.00					32.00		96.00											37.00		111.00				32.00		80.00				37.00				37.00			1.23	1.07		1.23	1.07	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											78.52	45		45				57.58	33		33										45		45				33		33			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					2.00		6.00											3.00		9.00				2.00		5.00				3.00				3.00			0.1	0.07		0.1	0.07	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								35.00		105.00					28.00		84.00											35.00		105.00				28.00		70.00				35.00				35.00			1.17	0.93		1.17	0.93	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.57	47		47				62.19	33		33										47		47				33		33			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		5.00				6.00				6.00			0.2	0.07		0.2	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								34.00		102.00					30.00		90.00											34.00		102.00				30.00		75.00				34.00				34.00			1.13	1.00		1.13	1.00	1.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.17	42		42				67.7	33		33										42		42				33		33			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		7.50				7.00				7.00			0.23	0.1		0.23	0.1	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		75.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.9	39		39				76.63	34		34										39		39				34		34			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		5.00				6.00				6.00			0.2	0.07		0.2	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					30.00		90.00											40.00		120.00				30.00		75.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.76	41		41				73.61	34		34										41		41				34		34			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					3.00		9.00											6.00		18.00				3.00		7.50				6.00				6.00			0.2	0.1		0.2	0.1	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								37.00		111.00					30.00		90.00											37.00		111.00				30.00		75.00				37.00				37.00			1.23	1.00		1.23	1.00	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.69	45		45				64.31	35		35										45		45				35		35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		5.00				4.00				4.00			0.13	0.07		0.13	0.07	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								33.00		99.00					28.00		84.00											33.00		99.00				28.00		70.00				33.00				33.00			1.1	0.93		1.1	0.93	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.71	44		44				65.78	33		33										44		44				33		33			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					3.00		9.00											6.00		18.00				3.00		7.50				6.00				6.00			0.2	0.1		0.2	0.1	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	3		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								36.00		108.00					31.00		93.00											36.00		108.00				31.00		77.50				36.00				36.00			1.2	1.03		1.2	1.03	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.66	42		42				65.73	33		33										42		42				33		33			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		5.00				4.00				4.00			0.13	0.07		0.13	0.07	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					30.00		90.00											40.00		120.00				30.00		75.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											78.65	45		45				69.91	40		40										45		45				40		40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		5.00				6.00				6.00			0.2	0.07		0.2	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								38.00		114.00					32.00		96.00											38.00		114.00				32.00		80.00				38.00				38.00			1.27	1.07		1.27	1.07	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.33	40		40				65.86	32		32										40		40				32		32			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	3		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								38.00		114.00					30.00		90.00											38.00		114.00				30.00		75.00				38.00				38.00			1.27	1.00		1.27	1.00	1.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											81.84	44		44				61.38	33		33										44		44				33		33			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								39.00		117.00					30.00		90.00											39.00		117.00				30.00		75.00				39.00				39.00			1.3	1.00		1.3	1.00	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.81	45		45				60.73	33		33										45		45				33		33			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		5.00				6.00				6.00			0.2	0.07		0.2	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								39.00		117.00					30.00		90.00											39.00		117.00				30.00		75.00				39.00				39.00			1.3	1.00		1.3	1.00	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.91	43		43				74.81	35		35										43		43				35		35			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								43.00		129.00					32.00		96.00											43.00		129.00				32.00		80.00				43.00				43.00			1.43	1.07		1.43	1.07	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.09	38		38				77.92	34		34										38		38				34		34			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								43.00		129.00					32.00		96.00											43.00		129.00				32.00		80.00				43.00				43.00			1.43	1.07		1.43	1.07	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.51	42		42				64.83	33		33										42		42				33		33			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		5.00				5.00				5.00			0.17	0.07		0.17	0.07	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		75.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											85.48	40		40				70.52	33		33										40		40				33		33			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.04	50		50				45.15	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	132	0		29	10	S4802_132_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		10.00				9.00				9.00			0.3	0.13		0.3	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											49.96	50		50				46.97	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	133	0		29	10	S4802_133_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		25.00				15.00				15.00			0.5	0.33		0.5	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.18	50		50				47.17	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	134	0		29	10	S4802_134_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		10.00				9.00				9.00			0.3	0.13		0.3	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.28	50		50				47.26	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	135	0		29	10	S4802_135_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		17.50				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.29	50		50				44.45	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	136	0		29	10	S4802_136_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.55	50		50				48.46	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	137	0		29	10	S4802_137_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.96	50		50				55.42	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	138	0		29	10	S4802_138_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.86	50		50				46.9	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	139	0		29	10	S4802_139_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.59	50		50				48.5	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	140	0		29	10	S4802_140_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											49.54	50		50				46.57	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	141	0		29	10	S4802_141_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											45.86	50		50				43.11	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	142	0		29	10	S4802_142_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		17.50				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											46.93	50		50				45.99	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	143	0		29	10	S4802_143_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.56	50		50				45.65	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	144	0		29	10	S4802_144_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.7	50		50				47.65	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	145	0		29	10	S4802_145_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_0	4		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_0	4		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		17.50				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_0	4		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_0	4		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.98	50		50				48.86	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	146	0		29	10	S4802_146_0	4		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51	50		50				47.94	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	147	0		29	10	S4802_147_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		17.50				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											45.85	50		50				43.1	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	148	0		29	10	S4802_148_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.69	50		50				44.83	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	149	0		29	10	S4802_149_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.49	50		50				45.58	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	150	0		29	10	S4802_150_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.35	50		50				46.42	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	151	0		29	10	S4802_151_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		17.50				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.26	50		50				44.42	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	152	0		29	10	S4802_152_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		10.00				9.00				9.00			0.3	0.13		0.3	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.84	50		50				44.97	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	153	0		29	10	S4802_153_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		17.50				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											44.04	50		50				41.4	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	154	0		29	10	S4802_154_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											44.87	50		50				43.97	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	155	0		29	10	S4802_155_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.09	50		50				47.08	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	156	0		29	10	S4802_156_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											49.64	50		50				46.66	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	157	0		29	10	S4802_157_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		17.50				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.56	50		50				45.64	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	158	0		29	10	S4802_158_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											49.63	50		50				46.65	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	159	0		29	10	S4802_159_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											49.74	50		50				47.75	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	160	0		29	10	S4802_160_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											52.36	50		50				50.26	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	161	0		29	10	S4802_161_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											47.16	50		50				44.33	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	162	0		29	10	S4802_162_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		17.50				12.00				12.00			0.4	0.23		0.4	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											55.82	50		50				52.47	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	163	0		29	10	S4802_163_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		20.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.8	50		50				55.66	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	164	0		29	10	S4802_164_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		15.00				11.00				11.00			0.37	0.2		0.37	0.2	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.68	50		50				45.76	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	165	0		29	10	S4802_165_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	170	0		29	10	S4802_170_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	170	0		29	10	S4802_170_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		15.00				15.00				15.00			0.5	0.2		0.5	0.2	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	170	0		29	10	S4802_170_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	170	0		29	10	S4802_170_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.03	50		50				46.03	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	170	0		29	10	S4802_170_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	171	0		29	10	S4802_171_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	171	0		29	10	S4802_171_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					8.00		24.00											15.00		45.00				8.00		20.00				15.00				15.00			0.5	0.27		0.5	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	171	0		29	10	S4802_171_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	171	0		29	10	S4802_171_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.3	50		50				46.27	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	171	0		29	10	S4802_171_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	172	0		29	10	S4802_172_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	172	0		29	10	S4802_172_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	172	0		29	10	S4802_172_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	172	0		29	10	S4802_172_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											55.74	50		50				51.28	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	172	0		29	10	S4802_172_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	173	0		29	10	S4802_173_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	173	0		29	10	S4802_173_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	173	0		29	10	S4802_173_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	173	0		29	10	S4802_173_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.17	50		50				52.01	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	173	0		29	10	S4802_173_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	174	0		29	10	S4802_174_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	174	0		29	10	S4802_174_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					8.00		24.00											15.00		45.00				8.00		20.00				15.00				15.00			0.5	0.27		0.5	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	174	0		29	10	S4802_174_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	174	0		29	10	S4802_174_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											52.88	50		50				48.65	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	174	0		29	10	S4802_174_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	175	0		29	10	S4802_175_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	175	0		29	10	S4802_175_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	175	0		29	10	S4802_175_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	175	0		29	10	S4802_175_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											55.9	50		50				51.42	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	175	0		29	10	S4802_175_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	176	0		29	10	S4802_176_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	176	0		29	10	S4802_176_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					7.00		21.00											15.00		45.00				7.00		17.50				15.00				15.00			0.5	0.23		0.5	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	176	0		29	10	S4802_176_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	176	0		29	10	S4802_176_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.06	50		50				49.73	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	176	0		29	10	S4802_176_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	177	0		29	10	S4802_177_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	177	0		29	10	S4802_177_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		15.00				15.00				15.00			0.5	0.2		0.5	0.2	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	177	0		29	10	S4802_177_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	177	0		29	10	S4802_177_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											52.35	50		50				50.25	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	177	0		29	10	S4802_177_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	178	0		29	10	S4802_178_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	178	0		29	10	S4802_178_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					8.00		24.00											15.00		45.00				8.00		20.00				15.00				15.00			0.5	0.27		0.5	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	178	0		29	10	S4802_178_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	178	0		29	10	S4802_178_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.97	50		50				47.82	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	178	0		29	10	S4802_178_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	179	0		29	10	S4802_179_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	179	0		29	10	S4802_179_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					7.00		21.00											15.00		45.00				7.00		17.50				15.00				15.00			0.5	0.23		0.5	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	179	0		29	10	S4802_179_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					39.00		117.00											47.00		141.00				39.00		97.50				47.00				47.00			1.57	1.3		1.57	1.3	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	179	0		29	10	S4802_179_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.13	50		50				46.12	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	179	0		29	10	S4802_179_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	180	0		29	10	S4802_180_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	180	0		29	10	S4802_180_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		15.00				15.00				15.00			0.5	0.2		0.5	0.2	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	180	0		29	10	S4802_180_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		105.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	180	0		29	10	S4802_180_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											52.6	50		50				48.39	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	180	0		29	10	S4802_180_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	181	0		29	10	S4802_181_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	181	0		29	10	S4802_181_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	181	0		29	10	S4802_181_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	181	0		29	10	S4802_181_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.19	50		50				46.18	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	181	0		29	10	S4802_181_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	182	0		29	10	S4802_182_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	182	0		29	10	S4802_182_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		15.00				15.00				15.00			0.5	0.2		0.5	0.2	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	182	0		29	10	S4802_182_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	182	0		29	10	S4802_182_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.57	50		50				52.04	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	182	0		29	10	S4802_182_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	183	0		29	10	S4802_183_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	183	0		29	10	S4802_183_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	183	0		29	10	S4802_183_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	183	0		29	10	S4802_183_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.09	50		50				53.44	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	183	0		29	10	S4802_183_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	184	0		29	10	S4802_184_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	184	0		29	10	S4802_184_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	184	0		29	10	S4802_184_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	184	0		29	10	S4802_184_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.24	50		50				53.58	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	184	0		29	10	S4802_184_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	185	0		29	10	S4802_185_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	185	0		29	10	S4802_185_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					7.00		21.00											15.00		45.00				7.00		17.50				15.00				15.00			0.5	0.23		0.5	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	185	0		29	10	S4802_185_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	185	0		29	10	S4802_185_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.43	50		50				54.92	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	185	0		29	10	S4802_185_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	186	0		29	10	S4802_186_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	186	0		29	10	S4802_186_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		15.00				15.00				15.00			0.5	0.2		0.5	0.2	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	186	0		29	10	S4802_186_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	186	0		29	10	S4802_186_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.39	50		50				53.72	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	186	0		29	10	S4802_186_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	187	0		29	10	S4802_187_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	187	0		29	10	S4802_187_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					3.00		9.00											15.00		45.00				3.00		7.50				15.00				15.00			0.5	0.1		0.5	0.1	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	187	0		29	10	S4802_187_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	187	0		29	10	S4802_187_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.58	50		50				53.9	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	187	0		29	10	S4802_187_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	188	0		29	10	S4802_188_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	188	0		29	10	S4802_188_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		15.00				15.00				15.00			0.5	0.2		0.5	0.2	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	188	0		29	10	S4802_188_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	188	0		29	10	S4802_188_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.01	50		50				55.21	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	188	0		29	10	S4802_188_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	189	0		29	10	S4802_189_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	189	0		29	10	S4802_189_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	189	0		29	10	S4802_189_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	189	0		29	10	S4802_189_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.36	50		50				56.99	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	189	0		29	10	S4802_189_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	190	0		29	10	S4802_190_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	190	0		29	10	S4802_190_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	190	0		29	10	S4802_190_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	190	0		29	10	S4802_190_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.85	50		50				55.06	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	190	0		29	10	S4802_190_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	191	0		29	10	S4802_191_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	191	0		29	10	S4802_191_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					4.00		12.00											15.00		45.00				4.00		10.00				15.00				15.00			0.5	0.13		0.5	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	191	0		29	10	S4802_191_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	191	0		29	10	S4802_191_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59	50		50				54.28	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	191	0		29	10	S4802_191_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	192	0		29	10	S4802_192_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	192	0		29	10	S4802_192_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		15.00				15.00				15.00			0.5	0.2		0.5	0.2	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	192	0		29	10	S4802_192_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	192	0		29	10	S4802_192_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.77	50		50				54.99	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	192	0		29	10	S4802_192_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	193	0		29	10	S4802_193_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	193	0		29	10	S4802_193_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					7.00		21.00											15.00		45.00				7.00		17.50				15.00				15.00			0.5	0.23		0.5	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	193	0		29	10	S4802_193_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	193	0		29	10	S4802_193_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.18	50		50				53.53	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	193	0		29	10	S4802_193_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	194	0		29	10	S4802_194_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	194	0		29	10	S4802_194_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					4.00		12.00											15.00		45.00				4.00		10.00				15.00				15.00			0.5	0.13		0.5	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	194	0		29	10	S4802_194_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	194	0		29	10	S4802_194_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.31	50		50				54.82	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	194	0		29	10	S4802_194_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	195	0		29	10	S4802_195_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	195	0		29	10	S4802_195_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					4.00		12.00											15.00		45.00				4.00		10.00				15.00				15.00			0.5	0.13		0.5	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	195	0		29	10	S4802_195_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					39.00		117.00											47.00		141.00				39.00		97.50				47.00				47.00			1.57	1.3		1.57	1.3	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	195	0		29	10	S4802_195_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.13	50		50				55.58	47		47										50		50				47		47			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	195	0		29	10	S4802_195_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	196	0		29	10	S4802_196_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	196	0		29	10	S4802_196_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	196	0		29	10	S4802_196_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					38.00		114.00											47.00		141.00				38.00		95.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	196	0		29	10	S4802_196_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.96	50		50				54.25	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	196	0		29	10	S4802_196_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	197	0		29	10	S4802_197_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	197	0		29	10	S4802_197_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					6.00		18.00											15.00		45.00				6.00		15.00				15.00				15.00			0.5	0.2		0.5	0.2	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	197	0		29	10	S4802_197_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	197	0		29	10	S4802_197_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											57.16	50		50				52.59	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	197	0		29	10	S4802_197_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	198	0		29	10	S4802_198_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	198	0		29	10	S4802_198_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					8.00		24.00											15.00		45.00				8.00		20.00				15.00				15.00			0.5	0.27		0.5	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	198	0		29	10	S4802_198_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					41.00		123.00											47.00		141.00				41.00		102.50				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	198	0		29	10	S4802_198_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.2	50		50				55.87	48		48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	198	0		29	10	S4802_198_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	199	0		29	10	S4802_199_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	199	0		29	10	S4802_199_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	199	0		29	10	S4802_199_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	199	0		29	10	S4802_199_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.25	50		50				53.59	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	199	0		29	10	S4802_199_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	200	0		29	10	S4802_200_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	200	0		29	10	S4802_200_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	200	0		29	10	S4802_200_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	200	0		29	10	S4802_200_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.14	50		50				53.48	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	200	0		29	10	S4802_200_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	201	0		29	10	S4802_201_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	201	0		29	10	S4802_201_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	201	0		29	10	S4802_201_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	201	0		29	10	S4802_201_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.56	50		50				54.8	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	201	0		29	10	S4802_201_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	202	0		29	10	S4802_202_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	202	0		29	10	S4802_202_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	202	0		29	10	S4802_202_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	202	0		29	10	S4802_202_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.14	50		50				53.49	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	202	0		29	10	S4802_202_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	203	0		29	10	S4802_203_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	203	0		29	10	S4802_203_0	5		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					5.00		15.00											15.00		45.00				5.00		12.50				15.00				15.00			0.5	0.17		0.5	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	203	0		29	10	S4802_203_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	203	0		29	10	S4802_203_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											59.66	50		50				54.88	46		46										50		50				46		46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	203	0		29	10	S4802_203_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	6		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	6		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					8.00	16.00	24.00											20.00	40.00	60.00				8.00	16.00	24.00				20.00				20.00			0.67	0.27		0.67	0.27	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	6		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	6		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.63	44	44	44				89.39	42	42	42										44	44	44				42	42	42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	6		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	6		N	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					3.00	6.00	9.00											15.00	30.00	45.00				3.00	6.00	9.00				15.00				15.00			0.50	0.10		0.50	0.10	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5540	004	0		29	10	S5540_004_0	6		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					6.00	12.00	18.00											20.00	40.00	60.00				6.00	12.00	18.00				20.00				20.00			0.67	0.20		0.67	0.20	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	6		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								45.00	90.00	135.00					30.00	60.00	90.00											45.00	90.00	135.00				30.00	60.00	90.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											85.94	50	50	50				74.03	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	22		22				36.00	20		20										22		22				20		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	36		36				76.00	35		35										36		36				35		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	5		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				72.00	39		39										50		50				39		39			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	19		19				27.00	16		16										19		19				16		16			19			19								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	49		49				67.00	35		35										49		49				35		35			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	006	0		29	10	S5552_006_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01		110	1				31		90	1	2				31		90	31		31								6.00		18.00					1.00		0.00											6.00		18.00				1.00		0.00				6.00				6.00			0.19	0.03		0.19	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	6		N	Generic	4	01	1	2	2	1		110	01		110	1				31		90	1	2				31		90	31		31								10.00		30.00					5.00		0.00											10.00		30.00				5.00		0.00				10.00				10.00			0.32	0.16		0.32	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				31		90	1	2				31		90	31		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		120.00				45.00				45.00			1.45	1.29		1.45	1.29	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				31		90	1	2				31		90	31		31											75.00	45		45				73.00	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								4.00		12.00					0.00		0.00													10.00						0.00				4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5		N	Generic	2	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								12.00		36.00					7.00		21.00													30.00						17.50				12.00				12.00			0.39	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											55.49	25		25				55.49	20		20												25						20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											84.31	50		50				84.31	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	5		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				31								31			31		31											993.70	25						993.70	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								4.00		12.00					0.00		0.00													10.00						0.00				4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5		N	Preferred Generic	4	01	1	1	1	3		110	01		100	1				31		90	1	2						90	31		31											1.12	15		15				1.12	10		10												15						10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	5		N	Generic	4	01	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					5.00		15.00													25.00						12.50				10.00				10.00			0.32	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5		N	Generic	4	01	1	1	2	3		110	01		100	1				31		90	1	2						90	31		31											3.44	15		15				3.44	10		10												15						10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	5		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								45.00		135.00					40.00		120.00													112.50						100.00				45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											79.56	50		50				79.56	35		35												50						35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				31								31			31		31											1292.78	33						1292.78	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											79.96	50	50	50				71.97	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								43.00	86.00	129.00					33.00	66.00	99.00					33.00	66.00	99.00																43.00				43.00			1.43	1.10	1.10			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											95.20	34	34	34				89.60	32	32	32				32	32	32															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	005	0		29	10	S5596_005_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											68.84	50	50	50				61.95	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	006	0		29	10	S5596_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	4		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	4		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								37.00	74.00	111.00					31.00	62.00	93.00					31.00	62.00	93.00																37.00				37.00			1.23	1.03	1.03			1.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											95.81	33	33	33				90.00	31	31	31				31	31	31															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	009	0		29	10	S5596_009_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											76.46	50	50	50				68.82	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	010	0		29	10	S5596_010_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								40.00	80.00	120.00					35.00	70.00	105.00					35.00	70.00	105.00																40.00				40.00			1.33	1.17	1.17			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											96.37	33	33	33				90.53	31	31	31				31	31	31															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	013	0		29	10	S5596_013_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											69.17	50	50	50				62.25	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	014	0		29	10	S5596_014_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								40.00	80.00	120.00					34.00	68.00	102.00					34.00	68.00	102.00																40.00				40.00			1.33	1.13	1.13			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											96.26	36	36	36				88.24	33	33	33				33	33	33															36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	017	0		29	10	S5596_017_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											67.73	50	50	50				60.96	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	018	0		29	10	S5596_018_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								37.00	74.00	111.00					32.00	64.00	96.00					32.00	64.00	96.00																37.00				37.00			1.23	1.07	1.07			1.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											95.33	29	29	29				88.75	27	27	27				27	27	27															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	033	0		29	10	S5596_033_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											91.81	50	50	50				82.63	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	034	0		29	10	S5596_034_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								38.00	76.00	114.00					32.00	64.00	96.00					32.00	64.00	96.00																38.00				38.00			1.27	1.07	1.07			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											96.52	38	38	38				86.36	34	34	34				34	34	34															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	043	0		29	10	S5596_043_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											69.02	50	50	50				62.12	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	044	0		29	10	S5596_044_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								46.00	92.00	138.00					36.00	72.00	108.00					36.00	72.00	108.00																46.00				46.00			1.53	1.20	1.20			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											98.67	33	33	33				92.69	31	31	31				31	31	31															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	046	0		29	10	S5596_046_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								36.00	72.00	108.00					30.00	60.00	90.00					30.00	60.00	90.00																36.00				36.00			1.20	1.00	1.00			1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											103.25	39	39	39				92.66	35	35	35				35	35	35															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	056	0		29	10	S5596_056_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											64.88	50	50	50				58.39	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	057	0		29	10	S5596_057_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								39.00	78.00	117.00					33.00	66.00	99.00					33.00	66.00	99.00																39.00				39.00			1.30	1.10	1.10			1.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											95.75	30	30	30				89.37	28	28	28				28	28	28															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	059	0		29	10	S5596_059_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											82.77	50	50	50				74.50	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	060	0		29	10	S5596_060_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								46.00	92.00	138.00					35.00	70.00	105.00					35.00	70.00	105.00																46.00				46.00			1.53	1.17	1.17			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											95.73	31	31	31				89.55	29	29	29				29	29	29															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	062	0		29	10	S5596_062_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											73.96	50	50	50				66.56	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	063	0		29	10	S5596_063_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	066	0		29	10	S5596_066_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	066	0		29	10	S5596_066_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	066	0		29	10	S5596_066_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	066	0		29	10	S5596_066_0	3		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	066	0		29	10	S5596_066_0	3		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											23.42	22	22	22				21.29	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	066	0		29	10	S5596_066_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											79.72	41	41	41				73.89	38	38	38				38	38	38															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	066	0		29	10	S5596_066_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	068	0		29	10	S5596_068_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	068	0		29	10	S5596_068_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	068	0		29	10	S5596_068_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	068	0		29	10	S5596_068_0	4		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	068	0		29	10	S5596_068_0	4		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											23.19	22	22	22				21.08	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	068	0		29	10	S5596_068_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											79.91	41	41	41				76.01	39	39	39				39	39	39															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	068	0		29	10	S5596_068_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	070	0		29	10	S5596_070_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	070	0		29	10	S5596_070_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	070	0		29	10	S5596_070_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	070	0		29	10	S5596_070_0	4		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	070	0		29	10	S5596_070_0	4		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											22.62	22	22	22				20.56	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	070	0		29	10	S5596_070_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											77.92	41	41	41				74.12	39	39	39				39	39	39															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	070	0		29	10	S5596_070_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	072	0		29	10	S5596_072_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	072	0		29	10	S5596_072_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	072	0		29	10	S5596_072_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	072	0		29	10	S5596_072_0	3		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	072	0		29	10	S5596_072_0	3		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											22.30	22	22	22				20.27	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	072	0		29	10	S5596_072_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											78.35	42	42	42				72.76	39	39	39				39	39	39															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	072	0		29	10	S5596_072_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	074	0		29	10	S5596_074_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	074	0		29	10	S5596_074_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	074	0		29	10	S5596_074_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	074	0		29	10	S5596_074_0	4		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	074	0		29	10	S5596_074_0	4		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											21.54	22	22	22				19.59	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	074	0		29	10	S5596_074_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											75.10	41	41	41				69.61	38	38	38				38	38	38															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	074	0		29	10	S5596_074_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	076	0		29	10	S5596_076_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	076	0		29	10	S5596_076_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	076	0		29	10	S5596_076_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	076	0		29	10	S5596_076_0	4		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	076	0		29	10	S5596_076_0	4		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											24.40	22	22	22				22.18	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	076	0		29	10	S5596_076_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											86.27	42	42	42				80.10	39	39	39				39	39	39															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	076	0		29	10	S5596_076_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	078	0		29	10	S5596_078_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	078	0		29	10	S5596_078_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	078	0		29	10	S5596_078_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	078	0		29	10	S5596_078_0	4		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	078	0		29	10	S5596_078_0	4		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											21.09	22	22	22				19.18	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	078	0		29	10	S5596_078_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											70.88	40	40	40				67.34	38	38	38				38	38	38															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	078	0		29	10	S5596_078_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	080	0		29	10	S5596_080_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	080	0		29	10	S5596_080_0	4		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	080	0		29	10	S5596_080_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	080	0		29	10	S5596_080_0	4		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	080	0		29	10	S5596_080_0	4		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											21.35	22	22	22				19.41	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	080	0		29	10	S5596_080_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											69.72	39	39	39				66.14	37	37	37				37	37	37															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	080	0		29	10	S5596_080_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	082	0		29	10	S5596_082_0	7		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	082	0		29	10	S5596_082_0	7		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	082	0		29	10	S5596_082_0	7		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	082	0		29	10	S5596_082_0	7		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	082	0		29	10	S5596_082_0	7		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											24.53	22	22	22				22.30	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	082	0		29	10	S5596_082_0	7		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											83.46	41	41	41				79.39	39	39	39				39	39	39															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	082	0		29	10	S5596_082_0	7		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	084	0		29	10	S5596_084_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	084	0		29	10	S5596_084_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	084	0		29	10	S5596_084_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	084	0		29	10	S5596_084_0	3		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5596	084	0		29	10	S5596_084_0	3		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											23.73	22	22	22				21.57	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	084	0		29	10	S5596_084_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											81.42	41	41	41				77.45	39	39	39				39	39	39															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	084	0		29	10	S5596_084_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	3		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	002	0		29	10	S5601_002_0	3		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	002	0		29	10	S5601_002_0	3		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	002	0		29	10	S5601_002_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.80	44	44	44				86.64	44	44	44										44	44	44				44	44	44				44		44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	002	0		29	10	S5601_002_0	3		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											891.95	27						680.07	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	003	0		29	10	S5601_003_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	003	0		29	10	S5601_003_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	003	0		29	10	S5601_003_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	003	0		29	10	S5601_003_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	003	0		29	10	S5601_003_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	003	0		29	10	S5601_003_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											86.11	50	50	50				65.08	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	003	0		29	10	S5601_003_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1093.42	33						778.92	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	004	0		29	10	S5601_004_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	004	0		29	10	S5601_004_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	004	0		29	10	S5601_004_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	004	0		29	10	S5601_004_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.39	41	41	41				72.52	41	41	41										41	41	41				41	41	41				41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	004	0		29	10	S5601_004_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											755.02	29						594.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	005	0		29	10	S5601_005_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	005	0		29	10	S5601_005_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	005	0		29	10	S5601_005_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	005	0		29	10	S5601_005_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	005	0		29	10	S5601_005_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	005	0		29	10	S5601_005_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.26	45	45	45				73.57	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	005	0		29	10	S5601_005_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1101.89	33						1121.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	006	0		29	10	S5601_006_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	006	0		29	10	S5601_006_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	006	0		29	10	S5601_006_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	006	0		29	10	S5601_006_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.30	40	40	40				72.30	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	006	0		29	10	S5601_006_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											598.22	27						595.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	007	0		29	10	S5601_007_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	007	0		29	10	S5601_007_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	007	0		29	10	S5601_007_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	007	0		29	10	S5601_007_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	007	0		29	10	S5601_007_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	007	0		29	10	S5601_007_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.69	48	48	48				73.92	48	48	48										48	48	48				48	48	48				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	007	0		29	10	S5601_007_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											886.49	33						840.30	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	008	0		29	10	S5601_008_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	008	0		29	10	S5601_008_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	008	0		29	10	S5601_008_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	008	0		29	10	S5601_008_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.16	40	40	40				73.72	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	008	0		29	10	S5601_008_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											811.48	27						621.72	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	009	0		29	10	S5601_009_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	009	0		29	10	S5601_009_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	009	0		29	10	S5601_009_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	009	0		29	10	S5601_009_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	009	0		29	10	S5601_009_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	009	0		29	10	S5601_009_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.62	48	48	48				72.36	48	48	48										48	48	48				48	48	48				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	009	0		29	10	S5601_009_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1260.40	33						1137.67	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	010	0		29	10	S5601_010_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	010	0		29	10	S5601_010_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	010	0		29	10	S5601_010_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	010	0		29	10	S5601_010_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											96.94	40	40	40				73.12	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	010	0		29	10	S5601_010_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											749.68	25						524.38	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	011	0		29	10	S5601_011_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	011	0		29	10	S5601_011_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	011	0		29	10	S5601_011_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	011	0		29	10	S5601_011_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	011	0		29	10	S5601_011_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	011	0		29	10	S5601_011_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.75	50	50	50				75.95	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	011	0		29	10	S5601_011_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											842.64	33						817.43	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	012	0		29	10	S5601_012_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	012	0		29	10	S5601_012_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	012	0		29	10	S5601_012_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	012	0		29	10	S5601_012_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											85.94	40	40	40				68.88	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	012	0		29	10	S5601_012_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											610.43	26						490.50	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	013	0		29	10	S5601_013_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	013	0		29	10	S5601_013_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	013	0		29	10	S5601_013_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	013	0		29	10	S5601_013_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	013	0		29	10	S5601_013_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	013	0		29	10	S5601_013_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.31	50	50	50				71.45	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	013	0		29	10	S5601_013_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											878.12	33						761.35	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	014	0		29	10	S5601_014_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	014	0		29	10	S5601_014_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	014	0		29	10	S5601_014_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	014	0		29	10	S5601_014_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.00	41	41	41				77.45	41	41	41										41	41	41				41	41	41				41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	014	0		29	10	S5601_014_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											854.30	26						647.14	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	015	0		29	10	S5601_015_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	015	0		29	10	S5601_015_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	015	0		29	10	S5601_015_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	015	0		29	10	S5601_015_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	015	0		29	10	S5601_015_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	015	0		29	10	S5601_015_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.64	50	50	50				69.17	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	015	0		29	10	S5601_015_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1212.78	33						827.58	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	016	0		29	10	S5601_016_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	016	0		29	10	S5601_016_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	016	0		29	10	S5601_016_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	016	0		29	10	S5601_016_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.19	40	40	40				78.52	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	016	0		29	10	S5601_016_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											913.91	27						707.96	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	017	0		29	10	S5601_017_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	017	0		29	10	S5601_017_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	017	0		29	10	S5601_017_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	017	0		29	10	S5601_017_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	017	0		29	10	S5601_017_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	017	0		29	10	S5601_017_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.11	50	50	50				67.98	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	017	0		29	10	S5601_017_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											851.28	33						543.44	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	018	0		29	10	S5601_018_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	018	0		29	10	S5601_018_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	018	0		29	10	S5601_018_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	018	0		29	10	S5601_018_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.95	42	42	42				82.06	42	42	42										42	42	42				42	42	42				42		42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	018	0		29	10	S5601_018_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											818.48	26						816.16	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	019	0		29	10	S5601_019_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	019	0		29	10	S5601_019_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	019	0		29	10	S5601_019_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	019	0		29	10	S5601_019_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	019	0		29	10	S5601_019_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	019	0		29	10	S5601_019_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											86.44	50	50	50				63.85	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	019	0		29	10	S5601_019_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1149.43	33						1210.76	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	020	0		29	10	S5601_020_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	020	0		29	10	S5601_020_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	020	0		29	10	S5601_020_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	020	0		29	10	S5601_020_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.69	41	41	41				78.40	41	41	41										41	41	41				41	41	41				41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	020	0		29	10	S5601_020_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											802.84	27						746.13	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	021	0		29	10	S5601_021_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	021	0		29	10	S5601_021_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	021	0		29	10	S5601_021_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	021	0		29	10	S5601_021_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	021	0		29	10	S5601_021_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	021	0		29	10	S5601_021_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											86.43	50	50	50				66.05	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	021	0		29	10	S5601_021_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1205.66	33						999.42	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	022	0		29	10	S5601_022_0	3		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	022	0		29	10	S5601_022_0	3		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	022	0		29	10	S5601_022_0	3		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	022	0		29	10	S5601_022_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.42	40	40	40				82.43	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	022	0		29	10	S5601_022_0	3		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											740.59	27						598.24	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	023	0		29	10	S5601_023_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	023	0		29	10	S5601_023_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	023	0		29	10	S5601_023_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	023	0		29	10	S5601_023_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	023	0		29	10	S5601_023_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	023	0		29	10	S5601_023_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.52	49	49	49				75.66	49	49	49										49	49	49				49	49	49				49		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	023	0		29	10	S5601_023_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1162.01	33						1130.47	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	024	0		29	10	S5601_024_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	024	0		29	10	S5601_024_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	024	0		29	10	S5601_024_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	024	0		29	10	S5601_024_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.76	40	40	40				65.93	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	024	0		29	10	S5601_024_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											835.89	27						539.34	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	025	0		29	10	S5601_025_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	025	0		29	10	S5601_025_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	025	0		29	10	S5601_025_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	025	0		29	10	S5601_025_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	025	0		29	10	S5601_025_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	025	0		29	10	S5601_025_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.27	50	50	50				61.97	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	025	0		29	10	S5601_025_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1071.13	33						813.27	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	026	0		29	10	S5601_026_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	026	0		29	10	S5601_026_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	026	0		29	10	S5601_026_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	026	0		29	10	S5601_026_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.75	40	40	40				69.75	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	026	0		29	10	S5601_026_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											702.38	28						569.95	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	027	0		29	10	S5601_027_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	027	0		29	10	S5601_027_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	027	0		29	10	S5601_027_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	027	0		29	10	S5601_027_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	027	0		29	10	S5601_027_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	027	0		29	10	S5601_027_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.63	50	50	50				60.42	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	027	0		29	10	S5601_027_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1321.22	33						752.38	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	028	0		29	10	S5601_028_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	028	0		29	10	S5601_028_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	028	0		29	10	S5601_028_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	028	0		29	10	S5601_028_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.19	47	47	47				79.29	47	47	47										47	47	47				47	47	47				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	028	0		29	10	S5601_028_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											844.83	25						682.55	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	029	0		29	10	S5601_029_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	029	0		29	10	S5601_029_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	029	0		29	10	S5601_029_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	029	0		29	10	S5601_029_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	029	0		29	10	S5601_029_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	029	0		29	10	S5601_029_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.87	50	50	50				66.07	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	029	0		29	10	S5601_029_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1059.56	33						917.33	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	030	0		29	10	S5601_030_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	030	0		29	10	S5601_030_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	030	0		29	10	S5601_030_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	030	0		29	10	S5601_030_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											92.67	40	40	40				70.65	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	030	0		29	10	S5601_030_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											935.08	27						1036.27	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	031	0		29	10	S5601_031_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	031	0		29	10	S5601_031_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	031	0		29	10	S5601_031_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	031	0		29	10	S5601_031_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	031	0		29	10	S5601_031_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	031	0		29	10	S5601_031_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.22	50	50	50				67.04	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	031	0		29	10	S5601_031_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											832.80	33						943.19	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	032	0		29	10	S5601_032_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	032	0		29	10	S5601_032_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	032	0		29	10	S5601_032_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	032	0		29	10	S5601_032_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.27	42	42	42				70.99	42	42	42										42	42	42				42	42	42				42		42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	032	0		29	10	S5601_032_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											662.97	29						555.17	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	033	0		29	10	S5601_033_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	033	0		29	10	S5601_033_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	033	0		29	10	S5601_033_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	033	0		29	10	S5601_033_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	033	0		29	10	S5601_033_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	033	0		29	10	S5601_033_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.53	50	50	50				60.02	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	033	0		29	10	S5601_033_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1076.68	33						791.29	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	034	0		29	10	S5601_034_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	034	0		29	10	S5601_034_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	034	0		29	10	S5601_034_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	034	0		29	10	S5601_034_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.10	45	45	45				75.05	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	034	0		29	10	S5601_034_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											727.99	26						695.06	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	035	0		29	10	S5601_035_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	035	0		29	10	S5601_035_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	035	0		29	10	S5601_035_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	035	0		29	10	S5601_035_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	035	0		29	10	S5601_035_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	035	0		29	10	S5601_035_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.22	50	50	50				66.68	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	035	0		29	10	S5601_035_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1070.39	33						922.65	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	036	0		29	10	S5601_036_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	036	0		29	10	S5601_036_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	036	0		29	10	S5601_036_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	036	0		29	10	S5601_036_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.57	40	40	40				76.93	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	036	0		29	10	S5601_036_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											741.24	28						721.67	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	037	0		29	10	S5601_037_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	037	0		29	10	S5601_037_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	037	0		29	10	S5601_037_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	037	0		29	10	S5601_037_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	037	0		29	10	S5601_037_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	037	0		29	10	S5601_037_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.15	50	50	50				62.69	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	037	0		29	10	S5601_037_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1253.71	33						689.25	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	038	0		29	10	S5601_038_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	038	0		29	10	S5601_038_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	038	0		29	10	S5601_038_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	038	0		29	10	S5601_038_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.92	40	40	40				73.87	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	038	0		29	10	S5601_038_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											778.11	28						1043.16	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	040	0		29	10	S5601_040_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	040	0		29	10	S5601_040_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	040	0		29	10	S5601_040_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	040	0		29	10	S5601_040_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.74	40	40	40				72.84	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	040	0		29	10	S5601_040_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											861.67	28						643.72	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	041	0		29	10	S5601_041_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	041	0		29	10	S5601_041_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	041	0		29	10	S5601_041_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	041	0		29	10	S5601_041_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	041	0		29	10	S5601_041_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	041	0		29	10	S5601_041_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.42	50	50	50				64.20	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	041	0		29	10	S5601_041_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											901.71	33						812.75	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	042	0		29	10	S5601_042_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	042	0		29	10	S5601_042_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	042	0		29	10	S5601_042_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	042	0		29	10	S5601_042_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											86.74	40	40	40				66.46	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	042	0		29	10	S5601_042_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											829.66	29						877.71	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	044	0		29	10	S5601_044_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	044	0		29	10	S5601_044_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	044	0		29	10	S5601_044_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	044	0		29	10	S5601_044_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.16	40	40	40				75.56	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	044	0		29	10	S5601_044_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											651.32	25						607.64	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	045	0		29	10	S5601_045_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	045	0		29	10	S5601_045_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	045	0		29	10	S5601_045_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	045	0		29	10	S5601_045_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	045	0		29	10	S5601_045_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	045	0		29	10	S5601_045_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.39	50	50	50				69.62	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	045	0		29	10	S5601_045_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1002.16	33						904.72	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	046	0		29	10	S5601_046_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	046	0		29	10	S5601_046_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	046	0		29	10	S5601_046_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	046	0		29	10	S5601_046_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.52	40	40	40				76.81	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	046	0		29	10	S5601_046_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											942.95	28						735.65	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	048	0		29	10	S5601_048_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	048	0		29	10	S5601_048_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	048	0		29	10	S5601_048_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	048	0		29	10	S5601_048_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.64	43	43	43				75.94	43	43	43										43	43	43				43	43	43				43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	048	0		29	10	S5601_048_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											879.06	28						699.93	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	049	0		29	10	S5601_049_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	049	0		29	10	S5601_049_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	049	0		29	10	S5601_049_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	049	0		29	10	S5601_049_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	049	0		29	10	S5601_049_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	049	0		29	10	S5601_049_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											80.07	50	50	50				63.09	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	049	0		29	10	S5601_049_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1078.57	33						891.79	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	050	0		29	10	S5601_050_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	050	0		29	10	S5601_050_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	050	0		29	10	S5601_050_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	050	0		29	10	S5601_050_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.51	47	47	47				75.76	46	46	46										47	47	47				46	46	46				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	050	0		29	10	S5601_050_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1011.01	28						610.76	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	051	0		29	10	S5601_051_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	051	0		29	10	S5601_051_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	051	0		29	10	S5601_051_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	051	0		29	10	S5601_051_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	051	0		29	10	S5601_051_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	051	0		29	10	S5601_051_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											83.25	50	50	50				60.49	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	051	0		29	10	S5601_051_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1519.59	33						1601.31	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	052	0		29	10	S5601_052_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	052	0		29	10	S5601_052_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	052	0		29	10	S5601_052_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	052	0		29	10	S5601_052_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.50	43	43	43				72.54	43	43	43										43	43	43				43	43	43				43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	052	0		29	10	S5601_052_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											799.32	27						624.29	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	053	0		29	10	S5601_053_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	053	0		29	10	S5601_053_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	053	0		29	10	S5601_053_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	053	0		29	10	S5601_053_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	053	0		29	10	S5601_053_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	053	0		29	10	S5601_053_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.83	50	50	50				74.52	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	053	0		29	10	S5601_053_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1101.76	33						906.05	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	054	0		29	10	S5601_054_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	054	0		29	10	S5601_054_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	054	0		29	10	S5601_054_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	054	0		29	10	S5601_054_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.19	41	41	41				81.13	41	41	41										41	41	41				41	41	41				41		41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	054	0		29	10	S5601_054_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											787.05	26						623.83	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	055	0		29	10	S5601_055_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	055	0		29	10	S5601_055_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	055	0		29	10	S5601_055_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	055	0		29	10	S5601_055_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	055	0		29	10	S5601_055_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	055	0		29	10	S5601_055_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.24	50	50	50				78.42	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	055	0		29	10	S5601_055_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1151.35	33						905.44	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	056	0		29	10	S5601_056_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	056	0		29	10	S5601_056_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								14.00	28.00	42.00					5.00	10.00	15.00											14.00	28.00	42.00				5.00	10.00	15.00					14.00			14.00			0.47	0.17		0.47	0.17	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	056	0		29	10	S5601_056_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	056	0		29	10	S5601_056_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.84	39	39	39				76.05	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	056	0		29	10	S5601_056_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											842.22	25						692.50	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	057	0		29	10	S5601_057_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	057	0		29	10	S5601_057_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	057	0		29	10	S5601_057_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	057	0		29	10	S5601_057_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	057	0		29	10	S5601_057_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	057	0		29	10	S5601_057_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.87	49	49	49				69.51	49	49	49										49	49	49				49	49	49				49		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	057	0		29	10	S5601_057_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1033.81	33						754.61	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	058	0		29	10	S5601_058_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	058	0		29	10	S5601_058_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								12.00	24.00	36.00					5.00	10.00	15.00											12.00	24.00	36.00				5.00	10.00	15.00					12.00			12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	058	0		29	10	S5601_058_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	058	0		29	10	S5601_058_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.37	36	36	36				73.94	36	36	36										36	36	36				36	36	36				36		36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	058	0		29	10	S5601_058_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											742.28	25						645.94	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	059	0		29	10	S5601_059_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	059	0		29	10	S5601_059_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	059	0		29	10	S5601_059_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	059	0		29	10	S5601_059_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	059	0		29	10	S5601_059_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	059	0		29	10	S5601_059_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.68	50	50	50				73.09	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	059	0		29	10	S5601_059_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											979.70	33						803.15	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	060	0		29	10	S5601_060_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	060	0		29	10	S5601_060_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	060	0		29	10	S5601_060_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	060	0		29	10	S5601_060_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											96.20	43	43	43				77.52	43	43	43										43	43	43				43	43	43				43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	060	0		29	10	S5601_060_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											878.34	28						606.03	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	061	0		29	10	S5601_061_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	061	0		29	10	S5601_061_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	061	0		29	10	S5601_061_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	061	0		29	10	S5601_061_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	061	0		29	10	S5601_061_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	061	0		29	10	S5601_061_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.91	50	50	50				72.99	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	061	0		29	10	S5601_061_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											849.84	33						664.37	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	062	0		29	10	S5601_062_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	062	0		29	10	S5601_062_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								12.00	24.00	36.00					5.00	10.00	15.00											12.00	24.00	36.00				5.00	10.00	15.00					12.00			12.00			0.40	0.17		0.40	0.17	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	062	0		29	10	S5601_062_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	062	0		29	10	S5601_062_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.63	43	43	43				75.34	43	43	43										43	43	43				43	43	43				43		43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	062	0		29	10	S5601_062_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											792.92	28						662.91	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	063	0		29	10	S5601_063_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	063	0		29	10	S5601_063_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	063	0		29	10	S5601_063_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	063	0		29	10	S5601_063_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	063	0		29	10	S5601_063_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	063	0		29	10	S5601_063_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.33	50	50	50				67.91	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	063	0		29	10	S5601_063_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1278.12	33						992.02	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	064	0		29	10	S5601_064_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	064	0		29	10	S5601_064_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	064	0		29	10	S5601_064_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	064	0		29	10	S5601_064_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.90	39	39	39				65.09	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	064	0		29	10	S5601_064_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											680.40	28						519.36	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	065	0		29	10	S5601_065_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	065	0		29	10	S5601_065_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	065	0		29	10	S5601_065_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	065	0		29	10	S5601_065_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	065	0		29	10	S5601_065_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	065	0		29	10	S5601_065_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.68	45	45	45				72.98	45	45	45										45	45	45				45	45	45				45		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	065	0		29	10	S5601_065_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1008.92	33						898.87	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	066	0		29	10	S5601_066_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	066	0		29	10	S5601_066_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	066	0		29	10	S5601_066_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	066	0		29	10	S5601_066_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.81	31	31	31				86.88	31	31	31										31	31	31				31	31	31				31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	066	0		29	10	S5601_066_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											713.29	25						623.59	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	067	0		29	10	S5601_067_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	067	0		29	10	S5601_067_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	067	0		29	10	S5601_067_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	067	0		29	10	S5601_067_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	067	0		29	10	S5601_067_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	067	0		29	10	S5601_067_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.66	50	50	50				76.37	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	067	0		29	10	S5601_067_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1227.17	33						991.90	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	068	0		29	10	S5601_068_0	2		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	068	0		29	10	S5601_068_0	2		N	Generic	3	11	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	068	0		29	10	S5601_068_0	2		N	Preferred Brand	3	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00					47.00			47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	068	0		29	10	S5601_068_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											85.52	40	40	40				69.42	40	40	40										40	40	40				40	40	40				40		40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	068	0		29	10	S5601_068_0	2		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											719.05	29						468.70	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	107	0		29	10	S5601_107_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	107	0		29	10	S5601_107_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	107	0		29	10	S5601_107_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	107	0		29	10	S5601_107_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	107	0		29	10	S5601_107_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	107	0		29	10	S5601_107_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											82.74	50	50	50				60.91	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	107	0		29	10	S5601_107_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1609.50	33						929.68	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	108	0		29	10	S5601_108_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	108	0		29	10	S5601_108_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	108	0		29	10	S5601_108_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	108	0		29	10	S5601_108_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	108	0		29	10	S5601_108_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	108	0		29	10	S5601_108_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.57	50	50	50				67.38	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	108	0		29	10	S5601_108_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1134.57	33						644.71	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	109	0		29	10	S5601_109_0	2		N	Preferred Generic	4	01	3	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	109	0		29	10	S5601_109_0	2		N	Preferred Generic	4	01	3	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	109	0		29	10	S5601_109_0	2		N	Generic	4	01	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												3
S5601	109	0		29	10	S5601_109_0	2		N	Generic	4	01	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
S5601	109	0		29	10	S5601_109_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	120.00											47.00	94.00	141.00				47.00	94.00	120.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	109	0		29	10	S5601_109_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.05	50	50	50				66.60	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	109	0		29	10	S5601_109_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											1002.16	33						690.56	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	176	0		29	10	S5601_176_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	176	0		29	10	S5601_176_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	176	0		29	10	S5601_176_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	176	0		29	10	S5601_176_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.60	50	50	50				93.66	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	176	0		29	10	S5601_176_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											825.52	25						909.37	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	177	0		29	10	S5601_177_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	177	0		29	10	S5601_177_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	177	0		29	10	S5601_177_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	177	0		29	10	S5601_177_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.03	50	50	50				92.15	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	177	0		29	10	S5601_177_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											830.44	25						917.14	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	178	0		29	10	S5601_178_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	178	0		29	10	S5601_178_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	178	0		29	10	S5601_178_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	178	0		29	10	S5601_178_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.57	50	50	50				95.99	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	178	0		29	10	S5601_178_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											860.06	25						961.90	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	179	0		29	10	S5601_179_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	179	0		29	10	S5601_179_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	179	0		29	10	S5601_179_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	179	0		29	10	S5601_179_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.72	50	50	50				94.90	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	179	0		29	10	S5601_179_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											856.54	25						969.26	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	180	0		29	10	S5601_180_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	180	0		29	10	S5601_180_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	180	0		29	10	S5601_180_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	180	0		29	10	S5601_180_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											96.54	50	50	50				91.76	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	180	0		29	10	S5601_180_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											825.68	25						923.27	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	181	0		29	10	S5601_181_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	181	0		29	10	S5601_181_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	181	0		29	10	S5601_181_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	181	0		29	10	S5601_181_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											96.57	50	50	50				91.82	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	181	0		29	10	S5601_181_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											827.94	25						919.12	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	182	0		29	10	S5601_182_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	182	0		29	10	S5601_182_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	182	0		29	10	S5601_182_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	182	0		29	10	S5601_182_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.06	50	50	50				89.50	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	182	0		29	10	S5601_182_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											808.51	25						908.13	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	183	0		29	10	S5601_183_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	183	0		29	10	S5601_183_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	183	0		29	10	S5601_183_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	183	0		29	10	S5601_183_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.90	50	50	50				87.37	48	48	48										50	50	50				48	48	48				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	183	0		29	10	S5601_183_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											809.52	25						914.24	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	184	0		29	10	S5601_184_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	184	0		29	10	S5601_184_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	184	0		29	10	S5601_184_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	184	0		29	10	S5601_184_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											96.85	50	50	50				89.29	48	48	48										50	50	50				48	48	48				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	184	0		29	10	S5601_184_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											821.91	25						931.12	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	185	0		29	10	S5601_185_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	185	0		29	10	S5601_185_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	185	0		29	10	S5601_185_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	185	0		29	10	S5601_185_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.57	50	50	50				87.98	48	48	48										50	50	50				48	48	48				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	185	0		29	10	S5601_185_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											809.03	25						920.92	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	186	0		29	10	S5601_186_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	186	0		29	10	S5601_186_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	186	0		29	10	S5601_186_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	186	0		29	10	S5601_186_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.48	50	50	50				88.50	48	48	48										50	50	50				48	48	48				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	186	0		29	10	S5601_186_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											819.39	25						924.13	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	187	0		29	10	S5601_187_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	187	0		29	10	S5601_187_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	187	0		29	10	S5601_187_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	187	0		29	10	S5601_187_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.40	50	50	50				78.84	46	46	46										50	50	50				46	46	46				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	187	0		29	10	S5601_187_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											794.60	25						884.64	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	188	0		29	10	S5601_188_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	188	0		29	10	S5601_188_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	188	0		29	10	S5601_188_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	188	0		29	10	S5601_188_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											95.99	50	50	50				91.52	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	188	0		29	10	S5601_188_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											819.25	25						903.33	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	189	0		29	10	S5601_189_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	189	0		29	10	S5601_189_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	189	0		29	10	S5601_189_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	189	0		29	10	S5601_189_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											93.77	50	50	50				88.10	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	189	0		29	10	S5601_189_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											797.24	25						883.75	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	190	0		29	10	S5601_190_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	190	0		29	10	S5601_190_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	190	0		29	10	S5601_190_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	190	0		29	10	S5601_190_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.38	50	50	50				78.04	45	45	45										50	50	50				45	45	45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	190	0		29	10	S5601_190_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											774.27	25						875.08	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	191	0		29	10	S5601_191_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	191	0		29	10	S5601_191_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	191	0		29	10	S5601_191_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	191	0		29	10	S5601_191_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.50	50	50	50				79.43	46	46	46										50	50	50				46	46	46				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	191	0		29	10	S5601_191_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											773.95	25						877.30	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	192	0		29	10	S5601_192_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	192	0		29	10	S5601_192_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	192	0		29	10	S5601_192_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	192	0		29	10	S5601_192_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											91.66	50	50	50				86.74	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	192	0		29	10	S5601_192_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											781.71	25						875.78	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	193	0		29	10	S5601_193_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	193	0		29	10	S5601_193_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	193	0		29	10	S5601_193_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	193	0		29	10	S5601_193_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.37	50	50	50				79.07	46	46	46										50	50	50				46	46	46				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	193	0		29	10	S5601_193_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											787.45	25						881.86	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	194	0		29	10	S5601_194_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	194	0		29	10	S5601_194_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	194	0		29	10	S5601_194_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	194	0		29	10	S5601_194_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											88.93	50	50	50				78.27	46	46	46										50	50	50				46	46	46				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	194	0		29	10	S5601_194_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											777.89	25						877.53	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	195	0		29	10	S5601_195_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	195	0		29	10	S5601_195_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	195	0		29	10	S5601_195_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	195	0		29	10	S5601_195_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.41	50	50	50				76.36	45	45	45										50	50	50				45	45	45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	195	0		29	10	S5601_195_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											791.67	25						882.11	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	196	0		29	10	S5601_196_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	196	0		29	10	S5601_196_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	196	0		29	10	S5601_196_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	196	0		29	10	S5601_196_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											87.68	50	50	50				75.51	45	45	45										50	50	50				45	45	45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	196	0		29	10	S5601_196_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											773.26	25						868.33	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	197	0		29	10	S5601_197_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	197	0		29	10	S5601_197_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	197	0		29	10	S5601_197_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	197	0		29	10	S5601_197_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.57	50	50	50				87.28	48	48	48										50	50	50				48	48	48				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	197	0		29	10	S5601_197_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											804.13	25						914.91	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	198	0		29	10	S5601_198_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	198	0		29	10	S5601_198_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	198	0		29	10	S5601_198_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	198	0		29	10	S5601_198_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											90.48	50	50	50				78.55	45	45	45										50	50	50				45	45	45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	198	0		29	10	S5601_198_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											867.18	25						906.49	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	199	0		29	10	S5601_199_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	199	0		29	10	S5601_199_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	199	0		29	10	S5601_199_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	199	0		29	10	S5601_199_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.41	50	50	50				76.83	45	45	45										50	50	50				45	45	45				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	199	0		29	10	S5601_199_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											772.01	25						872.22	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	200	0		29	10	S5601_200_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	200	0		29	10	S5601_200_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	200	0		29	10	S5601_200_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	200	0		29	10	S5601_200_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											92.12	50	50	50				80.98	46	46	46										50	50	50				46	46	46				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	200	0		29	10	S5601_200_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											779.21	25						884.31	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	201	0		29	10	S5601_201_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	201	0		29	10	S5601_201_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	201	0		29	10	S5601_201_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	201	0		29	10	S5601_201_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.76	50	50	50				92.48	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	201	0		29	10	S5601_201_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											807.78	25						900.88	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	202	0		29	10	S5601_202_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	202	0		29	10	S5601_202_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	202	0		29	10	S5601_202_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	202	0		29	10	S5601_202_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.27	48	48	48				94.01	47	47	47										48	48	48				47	47	47				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	202	0		29	10	S5601_202_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											873.57	25						965.96	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	203	0		29	10	S5601_203_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	203	0		29	10	S5601_203_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	203	0		29	10	S5601_203_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	203	0		29	10	S5601_203_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.52	50	50	50				93.87	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	203	0		29	10	S5601_203_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											825.09	25						914.47	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	204	0		29	10	S5601_204_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	204	0		29	10	S5601_204_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	204	0		29	10	S5601_204_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	204	0		29	10	S5601_204_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											97.76	50	50	50				92.65	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	204	0		29	10	S5601_204_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											831.71	25						919.47	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	205	0		29	10	S5601_205_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	205	0		29	10	S5601_205_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	205	0		29	10	S5601_205_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	205	0		29	10	S5601_205_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.50	50	50	50				93.67	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	205	0		29	10	S5601_205_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											815.07	25						910.67	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	206	0		29	10	S5601_206_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	206	0		29	10	S5601_206_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	206	0		29	10	S5601_206_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	206	0		29	10	S5601_206_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											94.83	50	50	50				88.69	49	49	49										50	50	50				49	49	49				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	206	0		29	10	S5601_206_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											801.48	25						904.22	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	207	0		29	10	S5601_207_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	207	0		29	10	S5601_207_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	207	0		29	10	S5601_207_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	207	0		29	10	S5601_207_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.41	49	49	49				93.53	48	48	48										49	49	49				48	48	48				49		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	207	0		29	10	S5601_207_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											856.76	25						949.09	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	208	0		29	10	S5601_208_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	208	0		29	10	S5601_208_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	208	0		29	10	S5601_208_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	208	0		29	10	S5601_208_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											99.84	47	47	47				92.86	46	46	46										47	47	47				46	46	46				47		47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	208	0		29	10	S5601_208_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											830.53	25						958.99	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	209	0		29	10	S5601_209_0	2		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00					19.00			19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	209	0		29	10	S5601_209_0	2		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					19.00	38.00	57.00											20.00	40.00	60.00				19.00	38.00	57.00					20.00			20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	209	0		29	10	S5601_209_0	2		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					46.00	92.00	138.00											47.00	94.00	141.00				46.00	92.00	138.00					47.00			47.00			1.57	1.53		1.57	1.53	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	209	0		29	10	S5601_209_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											98.52	48	48	48				93.74	47	47	47										48	48	48				47	47	47				48		48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5601	209	0		29	10	S5601_209_0	2		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											879.00	25						967.87	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												1
S5609	001	0		29	10	S5609_001_0	4		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	40.00					13.00	26.00	26.00					13.00	26.00	26.00																20.00				20.00			0.67	0.43	0.43			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											86.62	45	45	45				76.99	40	40	40				40	40	40															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											767.23	27						767.23	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5609	002	0		29	10	S5609_002_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.99	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	002	0		29	10	S5609_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				937.73	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	3		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					33.00	66.00	99.00											47.00	94.00	141.00				33.00	66.00	99.00				47.00				47.00			1.57	1.10		1.57	1.10	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.99	50	50	50				59.54	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	003	0		29	10	S5617_003_0	3		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					41.00	82.00	123.00											47.00	94.00	141.00				41.00	82.00	123.00				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.04	50	50	50				61.20	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	008	0		29	10	S5617_008_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	0.00				12.00				12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								35.00	70.00	105.00					25.00	50.00	75.00											35.00	70.00	105.00				25.00	50.00	75.00				35.00				35.00			1.17	0.83		1.17	0.83	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.33	50	50	50				67.12	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	013	0		29	10	S5617_013_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					44.00	88.00	132.00											47.00	94.00	141.00				44.00	88.00	132.00				47.00				47.00			1.57	1.47		1.57	1.47	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.69	50	50	50				56.75	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	018	0		29	10	S5617_018_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.84	50	50	50				62.09	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	053	0		29	10	S5617_053_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.09	50	50	50				67.65	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	068	0		29	10	S5617_068_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					41.00	82.00	123.00											47.00	94.00	141.00				41.00	82.00	123.00				47.00				47.00			1.57	1.37		1.57	1.37	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											59.96	50	50	50				51.60	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	088	0		29	10	S5617_088_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					30.00	60.00	90.00											45.00	90.00	135.00				30.00	60.00	90.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.54	50	50	50				61.68	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	103	0		29	10	S5617_103_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.82	50	50	50				64.54	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	108	0		29	10	S5617_108_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	0.00				12.00				12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								35.00	70.00	105.00					28.00	56.00	84.00											35.00	70.00	105.00				28.00	56.00	84.00				35.00				35.00			1.17	0.93		1.17	0.93	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											65.66	50	50	50				60.65	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	113	0		29	10	S5617_113_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.82	50	50	50				54.31	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	118	0		29	10	S5617_118_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					30.00	60.00	90.00											47.00	94.00	141.00				30.00	60.00	90.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.12	50	50	50				62.36	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	123	0		29	10	S5617_123_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											75.17	50	50	50				69.27	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	128	0		29	10	S5617_128_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.47	50	50	50				63.78	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	133	0		29	10	S5617_133_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					7.00	14.00	21.00											20.00	40.00	60.00				7.00	14.00	0.00				20.00				20.00			0.67	0.23		0.67	0.23	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											85.99	50	50	50				61.39	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	138	0		29	10	S5617_138_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	0.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.94	50	50	50				63.54	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	143	0		29	10	S5617_143_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					36.00	72.00	108.00											47.00	94.00	141.00				36.00	72.00	108.00				47.00				47.00			1.57	1.20		1.57	1.20	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.94	50	50	50				57.57	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	148	0		29	10	S5617_148_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					38.00	76.00	114.00											47.00	94.00	141.00				38.00	76.00	114.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.65	50	50	50				57.22	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	153	0		29	10	S5617_153_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	0.00				12.00				12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					30.00	60.00	90.00											47.00	94.00	141.00				30.00	60.00	90.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.14	50	50	50				74.79	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	158	0		29	10	S5617_158_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								16.00	32.00	48.00					2.00	4.00	6.00											16.00	32.00	48.00				2.00	4.00	0.00				16.00				16.00			0.53	0.07		0.53	0.07	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								44.00	88.00	132.00					30.00	60.00	90.00											44.00	88.00	132.00				30.00	60.00	90.00				44.00				44.00			1.47	1.00		1.47	1.00	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.00	50	50	50				63.52	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	163	0		29	10	S5617_163_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					33.00	66.00	99.00											47.00	94.00	141.00				33.00	66.00	99.00				47.00				47.00			1.57	1.10		1.57	1.10	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.05	50	50	50				68.95	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	214	0		29	10	S5617_214_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	0.00				12.00				12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					30.00	60.00	90.00											47.00	94.00	141.00				30.00	60.00	90.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.27	50	50	50				58.87	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	215	0		29	10	S5617_215_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.69	50	50	50				61.68	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	216	0		29	10	S5617_216_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					30.00	60.00	90.00											47.00	94.00	141.00				30.00	60.00	90.00				47.00				47.00			1.57	1.00		1.57	1.00	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											65.49	50	50	50				56.31	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	217	0		29	10	S5617_217_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											69.28	50	50	50				63.15	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	218	0		29	10	S5617_218_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.75	50	50	50				59.77	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	219	0		29	10	S5617_219_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					35.00	70.00	105.00											47.00	94.00	141.00				35.00	70.00	105.00				47.00				47.00			1.57	1.17		1.57	1.17	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											49.89	50	50	50				47.87	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	220	0		29	10	S5617_220_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					32.00	64.00	96.00											47.00	94.00	141.00				32.00	64.00	96.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.89	50	50	50				56.20	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	221	0		29	10	S5617_221_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					32.00	64.00	96.00											47.00	94.00	141.00				32.00	64.00	96.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.61	50	50	50				60.37	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	222	0		29	10	S5617_222_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	0.00				12.00				12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								35.00	70.00	105.00					30.00	60.00	90.00											35.00	70.00	105.00				30.00	60.00	90.00				35.00				35.00			1.17	1.00		1.17	1.00	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.54	50	50	50				53.14	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	223	0		29	10	S5617_223_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.88	50	50	50				60.56	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	224	0		29	10	S5617_224_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											55.25	50	50	50				47.89	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	225	0		29	10	S5617_225_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								9.00	18.00	27.00					0.00	0.00	0.00											9.00	18.00	27.00				0.00	0.00	0.00				9.00				9.00			0.30	0.00		0.30	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	226	0		29	10	S5617_226_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					1.00	2.00	3.00											19.00	38.00	57.00				1.00	2.00	0.00				19.00				19.00			0.63	0.03		0.63	0.03	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	226	0		29	10	S5617_226_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	226	0		29	10	S5617_226_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					32.00	64.00	96.00											47.00	94.00	141.00				32.00	64.00	96.00				47.00				47.00			1.57	1.07		1.57	1.07	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	226	0		29	10	S5617_226_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											51.01	50	50	50				51.33	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	226	0		29	10	S5617_226_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	226	0		29	10	S5617_226_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	2		N	Generic	3	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								12.00	24.00	36.00					2.00	4.00	6.00											12.00	24.00	36.00				2.00	4.00	0.00				12.00				12.00			0.40	0.07		0.40	0.07	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								45.00	90.00	135.00					30.00	60.00	90.00											45.00	90.00	135.00				30.00	60.00	90.00				45.00				45.00			1.50	1.00		1.50	1.00	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.06	50	50	50				59.80	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	227	0		29	10	S5617_227_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	3		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	246	0		29	10	S5617_246_0	3		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	3		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	246	0		29	10	S5617_246_0	3		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.97	50	50	50				70.98	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	246	0		29	10	S5617_246_0	3		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	247	0		29	10	S5617_247_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	247	0		29	10	S5617_247_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											90.72	50	50	50				77.14	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	247	0		29	10	S5617_247_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	248	0		29	10	S5617_248_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	248	0		29	10	S5617_248_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.53	50	50	50				73.70	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	248	0		29	10	S5617_248_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	249	0		29	10	S5617_249_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	249	0		29	10	S5617_249_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.86	50	50	50				72.65	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	249	0		29	10	S5617_249_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	250	0		29	10	S5617_250_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	250	0		29	10	S5617_250_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											99.94	50	50	50				77.91	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	250	0		29	10	S5617_250_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	251	0		29	10	S5617_251_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	251	0		29	10	S5617_251_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											80.87	50	50	50				82.65	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	251	0		29	10	S5617_251_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	252	0		29	10	S5617_252_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	252	0		29	10	S5617_252_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.25	50	50	50				80.41	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	252	0		29	10	S5617_252_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	253	0		29	10	S5617_253_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	253	0		29	10	S5617_253_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.66	50	50	50				84.26	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	253	0		29	10	S5617_253_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	254	0		29	10	S5617_254_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	254	0		29	10	S5617_254_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.91	50	50	50				64.75	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	254	0		29	10	S5617_254_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	255	0		29	10	S5617_255_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	255	0		29	10	S5617_255_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											76.72	50	50	50				61.94	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	255	0		29	10	S5617_255_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	256	0		29	10	S5617_256_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	256	0		29	10	S5617_256_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.90	50	50	50				72.86	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	256	0		29	10	S5617_256_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	257	0		29	10	S5617_257_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	257	0		29	10	S5617_257_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.74	50	50	50				66.65	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	257	0		29	10	S5617_257_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	258	0		29	10	S5617_258_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	258	0		29	10	S5617_258_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											87.08	50	50	50				71.81	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	258	0		29	10	S5617_258_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	259	0		29	10	S5617_259_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	259	0		29	10	S5617_259_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.79	50	50	50				72.49	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	259	0		29	10	S5617_259_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	260	0		29	10	S5617_260_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	260	0		29	10	S5617_260_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											66.56	50	50	50				66.33	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	260	0		29	10	S5617_260_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	261	0		29	10	S5617_261_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	261	0		29	10	S5617_261_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.68	50	50	50				73.34	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	261	0		29	10	S5617_261_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	262	0		29	10	S5617_262_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	262	0		29	10	S5617_262_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.68	50	50	50				74.36	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	262	0		29	10	S5617_262_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	263	0		29	10	S5617_263_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	263	0		29	10	S5617_263_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											78.76	50	50	50				68.87	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	263	0		29	10	S5617_263_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	264	0		29	10	S5617_264_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	264	0		29	10	S5617_264_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.67	50	50	50				92.35	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	264	0		29	10	S5617_264_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	265	0		29	10	S5617_265_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	265	0		29	10	S5617_265_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											77.41	50	50	50				66.67	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	265	0		29	10	S5617_265_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	266	0		29	10	S5617_266_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	266	0		29	10	S5617_266_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.25	50	50	50				61.33	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	266	0		29	10	S5617_266_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	267	0		29	10	S5617_267_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	267	0		29	10	S5617_267_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											73.18	50	50	50				71.87	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	267	0		29	10	S5617_267_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	268	0		29	10	S5617_268_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	268	0		29	10	S5617_268_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.79	50	50	50				61.73	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	268	0		29	10	S5617_268_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	269	0		29	10	S5617_269_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	269	0		29	10	S5617_269_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.74	50	50	50				72.61	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	269	0		29	10	S5617_269_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	270	0		29	10	S5617_270_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	270	0		29	10	S5617_270_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.04	50	50	50				74.45	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	270	0		29	10	S5617_270_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	271	0		29	10	S5617_271_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	271	0		29	10	S5617_271_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											82.12	50	50	50				71.42	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	271	0		29	10	S5617_271_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	272	0		29	10	S5617_272_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	272	0		29	10	S5617_272_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											96.44	50	50	50				76.48	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	272	0		29	10	S5617_272_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	273	0		29	10	S5617_273_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	273	0		29	10	S5617_273_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											83.15	50	50	50				68.62	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	273	0		29	10	S5617_273_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	274	0		29	10	S5617_274_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	274	0		29	10	S5617_274_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											91.94	50	50	50				77.55	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	274	0		29	10	S5617_274_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	275	0		29	10	S5617_275_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	275	0		29	10	S5617_275_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.41	50	50	50				67.78	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	275	0		29	10	S5617_275_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	276	0		29	10	S5617_276_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	276	0		29	10	S5617_276_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											94.93	50	50	50				83.28	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	276	0		29	10	S5617_276_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	277	0		29	10	S5617_277_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	277	0		29	10	S5617_277_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											98.22	49	49	49				79.11	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	277	0		29	10	S5617_277_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	278	0		29	10	S5617_278_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	278	0		29	10	S5617_278_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											86.84	50	50	50				74.10	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	278	0		29	10	S5617_278_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	0.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	279	0		29	10	S5617_279_0	2		Y	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	2		Y	Generic	4	01	1	2	2	3		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	279	0		29	10	S5617_279_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											95.23	50	50	50				79.18	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	279	0		29	10	S5617_279_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					0.00	0.00	0.00											11.00	22.00	33.00				0.00	0.00	0.00				11.00				11.00			0.37	0.00		0.37	0.00	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5617	280	0		29	10	S5617_280_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	280	0		29	10	S5617_280_0	3		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	280	0		29	10	S5617_280_0	3		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											20.27	20	20	20				18.20	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	280	0		29	10	S5617_280_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											74.28	49	49	49				54.98	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	280	0		29	10	S5617_280_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											27.51	20	20	20				22.54	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.80	50	50	50				51.43	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	281	0		29	10	S5617_281_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											24.76	20	20	20				20.87	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											60.11	41	41	41				52.10	40	40	40										41	41	41				40	40	40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	282	0		29	10	S5617_282_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											25.06	20	20	20				20.62	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											57.60	42	42	42				45.87	41	41	41										42	42	42				41	41	41			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	283	0		29	10	S5617_283_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											23.93	20	20	20				20.20	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.23	43	43	43				52.22	42	42	42										43	43	43				42	42	42			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	284	0		29	10	S5617_284_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											28.01	20	20	20				24.01	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											71.17	50	50	50				60.67	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	285	0		29	10	S5617_285_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											24.76	20	20	20				19.20	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											76.99	41	41	41				68.09	40	40	40										41	41	41				40	40	40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	286	0		29	10	S5617_286_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.11	20	20	20				19.17	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											52.17	43	43	43				43.04	42	42	42										43	43	43				42	42	42			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	287	0		29	10	S5617_287_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.73	20	20	20				19.54	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.16	48	48	48				50.45	47	47	47										48	48	48				47	47	47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	288	0		29	10	S5617_288_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											24.47	20	20	20				20.75	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.78	48	48	48				52.81	47	47	47										48	48	48				47	47	47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	289	0		29	10	S5617_289_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											25.68	20	20	20				20.51	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.73	46	46	46				50.17	46	46	46										46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	290	0		29	10	S5617_290_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											20.99	20	20	20				17.51	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.58	48	48	48				50.23	47	47	47										48	48	48				47	47	47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	291	0		29	10	S5617_291_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											20.55	20	20	20				16.46	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											67.47	47	47	47				53.88	46	46	46										47	47	47				46	46	46			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	292	0		29	10	S5617_292_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.14	20	20	20				18.22	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.54	49	49	49				52.72	49	49	49										49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	293	0		29	10	S5617_293_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											21.30	20	20	20				16.72	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											57.04	45	45	45				45.39	45	45	45										45	45	45				45	45	45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	294	0		29	10	S5617_294_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											20.28	20	20	20				17.71	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.67	47	47	47				56.06	46	46	46										47	47	47				46	46	46			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	295	0		29	10	S5617_295_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.90	20	20	20				17.98	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											79.24	50	50	50				55.45	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	296	0		29	10	S5617_296_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											23.99	20	20	20				19.08	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.50	48	48	48				59.36	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	297	0		29	10	S5617_297_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											20.46	20	20	20				16.80	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											53.00	43	43	43				47.40	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	298	0		29	10	S5617_298_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.96	20	20	20				19.24	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											56.67	48	48	48				47.07	47	47	47										48	48	48				47	47	47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	299	0		29	10	S5617_299_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.46	20	20	20				19.39	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											55.55	43	43	43				49.00	43	43	43										43	43	43				43	43	43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	300	0		29	10	S5617_300_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											25.97	20	20	20				20.39	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											84.10	48	48	48				58.23	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	301	0		29	10	S5617_301_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											24.20	20	20	20				20.14	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											62.20	46	46	46				49.03	45	45	45										46	46	46				45	45	45			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	302	0		29	10	S5617_302_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.52	20	20	20				17.94	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											61.52	50	50	50				52.50	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	303	0		29	10	S5617_303_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											22.71	20	20	20				21.86	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											60.13	50	50	50				55.50	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	304	0		29	10	S5617_304_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											25.14	20	20	20				22.08	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											92.87	46	46	46				66.00	45	45	45										46	46	46				45	45	45			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	305	0		29	10	S5617_305_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											24.98	20	20	20				22.62	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.13	50	50	50				61.57	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	306	0		29	10	S5617_306_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											20.28	20	20	20				16.98	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											68.42	49	49	49				51.38	48	48	48										49	49	49				48	48	48			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	307	0		29	10	S5617_307_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											23.75	20	20	20				20.49	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											81.77	48	48	48				60.86	48	48	48										48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	308	0		29	10	S5617_308_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											18.85	20	20	20				16.64	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											63.87	50	50	50				50.11	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	309	0		29	10	S5617_309_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											19.14	20	20	20				16.54	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											64.77	45	45	45				52.98	44	44	44										45	45	45				44	44	44			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	310	0		29	10	S5617_310_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											26.97	20	20	20				21.97	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											65.50	44	44	44				54.49	43	43	43										44	44	44				43	43	43			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	311	0		29	10	S5617_311_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											29.27	20	20	20				21.26	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											78.68	45	45	45				54.02	44	44	44										45	45	45				44	44	44			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	312	0		29	10	S5617_312_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	2		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					0.00	0.00	0.00											19.00	38.00	57.00				0.00	0.00	0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	2		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	0.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	2		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											24.33	20	20	20				21.30	18	18	18										20	20	20				18	18	18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	2	2				30	60	90	30		31											72.77	50	50	50				63.01	49	49	49										50	50	50				49	49	49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	313	0		29	10	S5617_313_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	104	0		29	10	S5660_104_0	2		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								12.00	24.00	36.00					3.00	6.00	9.00													36.00						0.00				12.00				12.00			0.40	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	104	0		29	10	S5660_104_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								30.00	60.00	90.00					24.00	48.00	72.00													90.00						72.00				30.00				30.00			1.00	0.80				0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	104	0		29	10	S5660_104_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											75.18	50	50	50				65.26	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	104	0		29	10	S5660_104_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	104	0		29	10	S5660_104_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	105	0		29	10	S5660_105_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	105	0		29	10	S5660_105_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	105	0		29	10	S5660_105_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					30.00	60.00	90.00													141.00						90.00				47.00				47.00			1.57	1.00				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	105	0		29	10	S5660_105_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											77.20	50	50	50				73.62	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	105	0		29	10	S5660_105_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	105	0		29	10	S5660_105_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	106	0		29	10	S5660_106_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	106	0		29	10	S5660_106_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								12.00	24.00	36.00					3.00	6.00	9.00													36.00						0.00				12.00				12.00			0.40	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	106	0		29	10	S5660_106_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								29.00	58.00	87.00					24.00	48.00	72.00													87.00						72.00				29.00				29.00			0.97	0.80				0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	106	0		29	10	S5660_106_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											82.71	50	50	50				74.64	49	49	49												50						49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	106	0		29	10	S5660_106_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	106	0		29	10	S5660_106_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	107	0		29	10	S5660_107_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	107	0		29	10	S5660_107_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								14.00	28.00	42.00					3.00	6.00	9.00													42.00						0.00				14.00				14.00			0.47	0.10				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	107	0		29	10	S5660_107_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								43.00	86.00	129.00					35.00	70.00	105.00													129.00						105.00				43.00				43.00			1.43	1.17				1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	107	0		29	10	S5660_107_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											77.15	48	48	48				69.21	47	47	47												48						47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	107	0		29	10	S5660_107_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	107	0		29	10	S5660_107_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	108	0		29	10	S5660_108_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	108	0		29	10	S5660_108_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								12.00	24.00	36.00					3.00	6.00	9.00													36.00						0.00				12.00				12.00			0.40	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	108	0		29	10	S5660_108_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								27.00	54.00	81.00					21.00	42.00	63.00													81.00						63.00				27.00				27.00			0.90	0.70				0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	108	0		29	10	S5660_108_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											70.94	50	50	50				66.36	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	108	0		29	10	S5660_108_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	108	0		29	10	S5660_108_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	109	0		29	10	S5660_109_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	109	0		29	10	S5660_109_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					4.00	8.00	12.00													60.00						0.00				20.00				20.00			0.67	0.13				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	109	0		29	10	S5660_109_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	109	0		29	10	S5660_109_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											83.06	50	50	50				75.52	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	109	0		29	10	S5660_109_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	109	0		29	10	S5660_109_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	110	0		29	10	S5660_110_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	110	0		29	10	S5660_110_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	110	0		29	10	S5660_110_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					30.00	60.00	90.00													141.00						90.00				47.00				47.00			1.57	1.00				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	110	0		29	10	S5660_110_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											65.98	50	50	50				61.81	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	110	0		29	10	S5660_110_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	110	0		29	10	S5660_110_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	111	0		29	10	S5660_111_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	111	0		29	10	S5660_111_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					5.00	10.00	15.00													60.00						0.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	111	0		29	10	S5660_111_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					41.00	82.00	123.00													141.00						123.00				47.00				47.00			1.57	1.37				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	111	0		29	10	S5660_111_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											64.34	50	50	50				54.65	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	111	0		29	10	S5660_111_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	111	0		29	10	S5660_111_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	112	0		29	10	S5660_112_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	112	0		29	10	S5660_112_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	112	0		29	10	S5660_112_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								35.00	70.00	105.00					29.00	58.00	87.00													105.00						87.00				35.00				35.00			1.17	0.97				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	112	0		29	10	S5660_112_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											69.14	50	50	50				64.19	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	112	0		29	10	S5660_112_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	112	0		29	10	S5660_112_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	113	0		29	10	S5660_113_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	113	0		29	10	S5660_113_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	113	0		29	10	S5660_113_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								37.00	74.00	111.00					30.00	60.00	90.00													111.00						90.00				37.00				37.00			1.23	1.00				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	113	0		29	10	S5660_113_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											83.17	50	50	50				69.43	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	113	0		29	10	S5660_113_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	113	0		29	10	S5660_113_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	114	0		29	10	S5660_114_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	114	0		29	10	S5660_114_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					4.00	8.00	12.00													60.00						0.00				20.00				20.00			0.67	0.13				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	114	0		29	10	S5660_114_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					34.00	68.00	102.00													141.00						102.00				47.00				47.00			1.57	1.13				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	114	0		29	10	S5660_114_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											69.94	50	50	50				62.11	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	114	0		29	10	S5660_114_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	114	0		29	10	S5660_114_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	115	0		29	10	S5660_115_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	115	0		29	10	S5660_115_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								12.00	24.00	36.00					4.00	8.00	12.00													36.00						0.00				12.00				12.00			0.40	0.13				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	115	0		29	10	S5660_115_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								32.00	64.00	96.00					25.00	50.00	75.00													96.00						75.00				32.00				32.00			1.07	0.83				1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	115	0		29	10	S5660_115_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											73.60	48	48	48				66.58	47	47	47												48						47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	115	0		29	10	S5660_115_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	115	0		29	10	S5660_115_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	116	0		29	10	S5660_116_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	116	0		29	10	S5660_116_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					4.00	8.00	12.00													60.00						0.00				20.00				20.00			0.67	0.13				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	116	0		29	10	S5660_116_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					47.00	94.00	141.00													141.00						141.00				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	116	0		29	10	S5660_116_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											66.72	50	50	50				67.09	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	116	0		29	10	S5660_116_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	116	0		29	10	S5660_116_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								8.00	16.00	24.00					0.00	0.00	0.00													24.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	117	0		29	10	S5660_117_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	117	0		29	10	S5660_117_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								17.00	34.00	51.00					3.00	6.00	9.00													51.00						0.00				17.00				17.00			0.57	0.10				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	117	0		29	10	S5660_117_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								40.00	80.00	120.00					31.00	62.00	93.00													120.00						93.00				40.00				40.00			1.33	1.03				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	117	0		29	10	S5660_117_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											69.84	50	50	50				62.32	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	117	0		29	10	S5660_117_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	117	0		29	10	S5660_117_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	118	0		29	10	S5660_118_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	118	0		29	10	S5660_118_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								15.00	30.00	45.00					3.00	6.00	9.00													45.00						0.00				15.00				15.00			0.50	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	118	0		29	10	S5660_118_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								45.00	90.00	135.00					30.00	60.00	90.00													135.00						90.00				45.00				45.00			1.50	1.00				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	118	0		29	10	S5660_118_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											78.81	50	50	50				65.35	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	118	0		29	10	S5660_118_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	118	0		29	10	S5660_118_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	119	0		29	10	S5660_119_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	119	0		29	10	S5660_119_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	119	0		29	10	S5660_119_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					39.00	78.00	117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	119	0		29	10	S5660_119_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											84.59	50	50	50				68.62	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	119	0		29	10	S5660_119_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	119	0		29	10	S5660_119_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	120	0		29	10	S5660_120_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	120	0		29	10	S5660_120_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	120	0		29	10	S5660_120_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					32.00	64.00	96.00													141.00						96.00				47.00				47.00			1.57	1.07				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	120	0		29	10	S5660_120_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											75.65	50	50	50				64.38	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	120	0		29	10	S5660_120_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	120	0		29	10	S5660_120_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	121	0		29	10	S5660_121_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	121	0		29	10	S5660_121_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	121	0		29	10	S5660_121_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	121	0		29	10	S5660_121_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											62.76	50	50	50				58.85	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	121	0		29	10	S5660_121_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	121	0		29	10	S5660_121_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	122	0		29	10	S5660_122_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	122	0		29	10	S5660_122_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	122	0		29	10	S5660_122_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					41.00	82.00	123.00													141.00						123.00				47.00				47.00			1.57	1.37				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	122	0		29	10	S5660_122_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											71.11	50	50	50				61.08	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	122	0		29	10	S5660_122_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	122	0		29	10	S5660_122_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	123	0		29	10	S5660_123_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	123	0		29	10	S5660_123_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	123	0		29	10	S5660_123_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								28.00	56.00	84.00					23.00	46.00	69.00													84.00						69.00				28.00				28.00			0.93	0.77				0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	123	0		29	10	S5660_123_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											80.14	46	46	46				63.45	46	46	46												46						46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	123	0		29	10	S5660_123_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	123	0		29	10	S5660_123_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								7.00	14.00	21.00					0.00	0.00	0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	124	0		29	10	S5660_124_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	124	0		29	10	S5660_124_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	124	0		29	10	S5660_124_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	124	0		29	10	S5660_124_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											89.57	50	50	50				74.82	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	124	0		29	10	S5660_124_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	124	0		29	10	S5660_124_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	125	0		29	10	S5660_125_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	125	0		29	10	S5660_125_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								15.00	30.00	45.00					3.00	6.00	9.00													45.00						0.00				15.00				15.00			0.50	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	125	0		29	10	S5660_125_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								46.00	92.00	138.00					30.00	60.00	90.00													138.00						90.00				46.00				46.00			1.53	1.00				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	125	0		29	10	S5660_125_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											65.62	50	50	50				55.24	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	125	0		29	10	S5660_125_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	125	0		29	10	S5660_125_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	126	0		29	10	S5660_126_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	126	0		29	10	S5660_126_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	126	0		29	10	S5660_126_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	126	0		29	10	S5660_126_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											67.06	50	50	50				58.69	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	126	0		29	10	S5660_126_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	126	0		29	10	S5660_126_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	127	0		29	10	S5660_127_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	127	0		29	10	S5660_127_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	127	0		29	10	S5660_127_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					41.00	82.00	123.00													141.00						123.00				47.00				47.00			1.57	1.37				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	127	0		29	10	S5660_127_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											69.00	50	50	50				61.73	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	127	0		29	10	S5660_127_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	127	0		29	10	S5660_127_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	128	0		29	10	S5660_128_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	128	0		29	10	S5660_128_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					8.00	16.00	24.00													60.00						0.00				20.00				20.00			0.67	0.27				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	128	0		29	10	S5660_128_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					47.00	94.00	141.00													141.00						141.00				47.00				47.00			1.57	1.57				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	128	0		29	10	S5660_128_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											74.12	50	50	50				64.95	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	128	0		29	10	S5660_128_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	128	0		29	10	S5660_128_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								9.00	18.00	27.00					0.00	0.00	0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	129	0		29	10	S5660_129_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	129	0		29	10	S5660_129_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					6.00	12.00	18.00													60.00						0.00				20.00				20.00			0.67	0.20				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	129	0		29	10	S5660_129_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					43.00	86.00	129.00													141.00						129.00				47.00				47.00			1.57	1.43				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	129	0		29	10	S5660_129_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											78.52	49	49	49				70.30	47	47	47												49						47			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	129	0		29	10	S5660_129_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	129	0		29	10	S5660_129_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								9.00	18.00	27.00					0.00	0.00	0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	130	0		29	10	S5660_130_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	130	0		29	10	S5660_130_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					9.00	18.00	27.00													60.00						0.00				20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	130	0		29	10	S5660_130_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					46.00	92.00	138.00													141.00						138.00				47.00				47.00			1.57	1.53				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	130	0		29	10	S5660_130_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											99.33	49	49	49				74.11	49	49	49												49						49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	130	0		29	10	S5660_130_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	130	0		29	10	S5660_130_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								9.00	18.00	27.00					0.00	0.00	0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	131	0		29	10	S5660_131_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	131	0		29	10	S5660_131_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					4.00	8.00	12.00													60.00						0.00				20.00				20.00			0.67	0.13				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	131	0		29	10	S5660_131_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					39.00	78.00	117.00													141.00						117.00				47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	131	0		29	10	S5660_131_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											79.22	50	50	50				69.19	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	131	0		29	10	S5660_131_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	131	0		29	10	S5660_131_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								9.00	18.00	27.00					0.00	0.00	0.00													27.00						0.00				9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	132	0		29	10	S5660_132_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	132	0		29	10	S5660_132_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					5.00	10.00	15.00													60.00						0.00				20.00				20.00			0.67	0.17				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	132	0		29	10	S5660_132_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								40.00	80.00	120.00					35.00	70.00	105.00													120.00						105.00				40.00				40.00			1.33	1.17				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	132	0		29	10	S5660_132_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											96.34	48	48	48				83.26	47	47	47												48						47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	132	0		29	10	S5660_132_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	132	0		29	10	S5660_132_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								7.00	14.00	21.00					0.00	0.00	0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	133	0		29	10	S5660_133_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	133	0		29	10	S5660_133_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					8.00	16.00	24.00													60.00						0.00				20.00				20.00			0.67	0.27				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	133	0		29	10	S5660_133_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								45.00	90.00	135.00					34.00	68.00	102.00													135.00						102.00				45.00				45.00			1.50	1.13				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	133	0		29	10	S5660_133_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											68.13	48	48	48				59.76	46	46	46												48						46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	133	0		29	10	S5660_133_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	133	0		29	10	S5660_133_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								7.00	14.00	21.00					0.00	0.00	0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	134	0		29	10	S5660_134_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	134	0		29	10	S5660_134_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								15.00	30.00	45.00					3.00	6.00	9.00													45.00						0.00				15.00				15.00			0.50	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	134	0		29	10	S5660_134_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					30.00	60.00	90.00													141.00						90.00				47.00				47.00			1.57	1.00				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	134	0		29	10	S5660_134_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											76.88	50	50	50				69.88	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	134	0		29	10	S5660_134_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	134	0		29	10	S5660_134_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	135	0		29	10	S5660_135_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	135	0		29	10	S5660_135_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	135	0		29	10	S5660_135_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					40.00	80.00	120.00													141.00						120.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	135	0		29	10	S5660_135_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											91.38	50	50	50				82.35	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	135	0		29	10	S5660_135_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	135	0		29	10	S5660_135_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	136	0		29	10	S5660_136_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					1.00	2.00	3.00													57.00						0.00				19.00				19.00			0.63	0.03				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	136	0		29	10	S5660_136_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					3.00	6.00	9.00													60.00						0.00				20.00				20.00			0.67	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	136	0		29	10	S5660_136_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	136	0		29	10	S5660_136_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											86.78	50	50	50				75.42	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	136	0		29	10	S5660_136_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	136	0		29	10	S5660_136_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	137	0		29	10	S5660_137_0	1		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	137	0		29	10	S5660_137_0	1		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								12.00	24.00	36.00					3.00	6.00	9.00													36.00						0.00				12.00				12.00			0.40	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	137	0		29	10	S5660_137_0	1		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					30.00	60.00	90.00													141.00						90.00				47.00				47.00			1.57	1.00				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	137	0		29	10	S5660_137_0	1		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											74.72	50	50	50				70.19	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	137	0		29	10	S5660_137_0	1		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	137	0		29	10	S5660_137_0	1		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								5.00	10.00	15.00					0.00	0.00	0.00													15.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	172	0		29	10	S5660_172_0	2		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	172	0		29	10	S5660_172_0	2		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	172	0		29	10	S5660_172_0	2		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	172	0		29	10	S5660_172_0	2		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	172	0		29	10	S5660_172_0	2		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	172	0		29	10	S5660_172_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											94.22	50	50	50				88.04	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	172	0		29	10	S5660_172_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	172	0		29	10	S5660_172_0	2		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	176	0		29	10	S5660_176_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	176	0		29	10	S5660_176_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	176	0		29	10	S5660_176_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	176	0		29	10	S5660_176_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	176	0		29	10	S5660_176_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	176	0		29	10	S5660_176_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											86.95	50	50	50				80.28	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	176	0		29	10	S5660_176_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	176	0		29	10	S5660_176_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	180	0		29	10	S5660_180_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	180	0		29	10	S5660_180_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	180	0		29	10	S5660_180_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	180	0		29	10	S5660_180_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	180	0		29	10	S5660_180_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	180	0		29	10	S5660_180_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											84.01	50	50	50				79.49	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	180	0		29	10	S5660_180_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	180	0		29	10	S5660_180_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	181	0		29	10	S5660_181_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	181	0		29	10	S5660_181_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	181	0		29	10	S5660_181_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	181	0		29	10	S5660_181_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	181	0		29	10	S5660_181_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	181	0		29	10	S5660_181_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											99.38	50	50	50				89.16	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	181	0		29	10	S5660_181_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	181	0		29	10	S5660_181_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	182	0		29	10	S5660_182_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	182	0		29	10	S5660_182_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	182	0		29	10	S5660_182_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	182	0		29	10	S5660_182_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	182	0		29	10	S5660_182_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	182	0		29	10	S5660_182_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											81.06	50	50	50				80.41	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	182	0		29	10	S5660_182_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	182	0		29	10	S5660_182_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	183	0		29	10	S5660_183_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	183	0		29	10	S5660_183_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	183	0		29	10	S5660_183_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	183	0		29	10	S5660_183_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	183	0		29	10	S5660_183_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	183	0		29	10	S5660_183_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											97.94	46	46	46				98.87	46	46	46												46						46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	183	0		29	10	S5660_183_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	183	0		29	10	S5660_183_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	184	0		29	10	S5660_184_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	184	0		29	10	S5660_184_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	184	0		29	10	S5660_184_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	184	0		29	10	S5660_184_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	184	0		29	10	S5660_184_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	184	0		29	10	S5660_184_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											94.05	50	50	50				74.12	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	184	0		29	10	S5660_184_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	184	0		29	10	S5660_184_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	185	0		29	10	S5660_185_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	185	0		29	10	S5660_185_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	185	0		29	10	S5660_185_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	185	0		29	10	S5660_185_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	185	0		29	10	S5660_185_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	185	0		29	10	S5660_185_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											95.58	50	50	50				87.87	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	185	0		29	10	S5660_185_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	185	0		29	10	S5660_185_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	186	0		29	10	S5660_186_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	186	0		29	10	S5660_186_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	186	0		29	10	S5660_186_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	186	0		29	10	S5660_186_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	186	0		29	10	S5660_186_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	186	0		29	10	S5660_186_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											86.16	50	50	50				82.09	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	186	0		29	10	S5660_186_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	186	0		29	10	S5660_186_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	187	0		29	10	S5660_187_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	187	0		29	10	S5660_187_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	187	0		29	10	S5660_187_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	187	0		29	10	S5660_187_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	187	0		29	10	S5660_187_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	187	0		29	10	S5660_187_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											78.43	50	50	50				80.98	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	187	0		29	10	S5660_187_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	187	0		29	10	S5660_187_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	190	0		29	10	S5660_190_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	190	0		29	10	S5660_190_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	190	0		29	10	S5660_190_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	190	0		29	10	S5660_190_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	190	0		29	10	S5660_190_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	190	0		29	10	S5660_190_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											88.18	50	50	50				91.56	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	190	0		29	10	S5660_190_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	190	0		29	10	S5660_190_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	192	0		29	10	S5660_192_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	192	0		29	10	S5660_192_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	192	0		29	10	S5660_192_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	192	0		29	10	S5660_192_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	192	0		29	10	S5660_192_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	192	0		29	10	S5660_192_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											83.43	50	50	50				85.07	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	192	0		29	10	S5660_192_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	192	0		29	10	S5660_192_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	194	0		29	10	S5660_194_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	194	0		29	10	S5660_194_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	194	0		29	10	S5660_194_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	194	0		29	10	S5660_194_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	194	0		29	10	S5660_194_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	194	0		29	10	S5660_194_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											99.77	50	50	50				95.23	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	194	0		29	10	S5660_194_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	194	0		29	10	S5660_194_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	195	0		29	10	S5660_195_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	195	0		29	10	S5660_195_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	195	0		29	10	S5660_195_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	195	0		29	10	S5660_195_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	195	0		29	10	S5660_195_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	195	0		29	10	S5660_195_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											79.25	50	50	50				80.48	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	195	0		29	10	S5660_195_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	195	0		29	10	S5660_195_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	196	0		29	10	S5660_196_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	196	0		29	10	S5660_196_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	196	0		29	10	S5660_196_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	196	0		29	10	S5660_196_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	196	0		29	10	S5660_196_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	196	0		29	10	S5660_196_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											99.11	50	50	50				98.02	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	196	0		29	10	S5660_196_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	196	0		29	10	S5660_196_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	197	0		29	10	S5660_197_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	197	0		29	10	S5660_197_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	197	0		29	10	S5660_197_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	197	0		29	10	S5660_197_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	197	0		29	10	S5660_197_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	197	0		29	10	S5660_197_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											89.97	50	50	50				90.52	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	197	0		29	10	S5660_197_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	197	0		29	10	S5660_197_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	198	0		29	10	S5660_198_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	198	0		29	10	S5660_198_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	198	0		29	10	S5660_198_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	198	0		29	10	S5660_198_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	198	0		29	10	S5660_198_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	198	0		29	10	S5660_198_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											94.46	50	50	50				95.16	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	198	0		29	10	S5660_198_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	198	0		29	10	S5660_198_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	199	0		29	10	S5660_199_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	199	0		29	10	S5660_199_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	199	0		29	10	S5660_199_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	199	0		29	10	S5660_199_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	199	0		29	10	S5660_199_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	199	0		29	10	S5660_199_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											95.67	50	50	50				90.97	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	199	0		29	10	S5660_199_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	199	0		29	10	S5660_199_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	202	0		29	10	S5660_202_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	202	0		29	10	S5660_202_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	202	0		29	10	S5660_202_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	202	0		29	10	S5660_202_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	202	0		29	10	S5660_202_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	202	0		29	10	S5660_202_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											99.85	49	49	49				89.09	49	49	49												49						49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	202	0		29	10	S5660_202_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	202	0		29	10	S5660_202_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	203	0		29	10	S5660_203_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	203	0		29	10	S5660_203_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	203	0		29	10	S5660_203_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	203	0		29	10	S5660_203_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	203	0		29	10	S5660_203_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	203	0		29	10	S5660_203_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											99.67	49	49	49				90.95	49	49	49												49						49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	203	0		29	10	S5660_203_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	203	0		29	10	S5660_203_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	204	0		29	10	S5660_204_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	204	0		29	10	S5660_204_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	204	0		29	10	S5660_204_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	204	0		29	10	S5660_204_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	204	0		29	10	S5660_204_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	204	0		29	10	S5660_204_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											99.67	48	48	48				93.40	48	48	48												48						48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	204	0		29	10	S5660_204_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	204	0		29	10	S5660_204_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	206	0		29	10	S5660_206_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	206	0		29	10	S5660_206_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	206	0		29	10	S5660_206_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	206	0		29	10	S5660_206_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	206	0		29	10	S5660_206_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	206	0		29	10	S5660_206_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											92.41	50	50	50				86.38	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	206	0		29	10	S5660_206_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	206	0		29	10	S5660_206_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	207	0		29	10	S5660_207_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	207	0		29	10	S5660_207_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	207	0		29	10	S5660_207_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	207	0		29	10	S5660_207_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	207	0		29	10	S5660_207_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	207	0		29	10	S5660_207_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											99.28	47	47	47				97.56	47	47	47												47						47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	207	0		29	10	S5660_207_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	207	0		29	10	S5660_207_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	208	0		29	10	S5660_208_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	208	0		29	10	S5660_208_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	208	0		29	10	S5660_208_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	208	0		29	10	S5660_208_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	208	0		29	10	S5660_208_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	208	0		29	10	S5660_208_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											95.08	50	50	50				86.88	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	208	0		29	10	S5660_208_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	208	0		29	10	S5660_208_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	209	0		29	10	S5660_209_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	209	0		29	10	S5660_209_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	209	0		29	10	S5660_209_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	209	0		29	10	S5660_209_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	209	0		29	10	S5660_209_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	209	0		29	10	S5660_209_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											78.98	50	50	50				77.79	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	209	0		29	10	S5660_209_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	209	0		29	10	S5660_209_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	210	0		29	10	S5660_210_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	210	0		29	10	S5660_210_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	210	0		29	10	S5660_210_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	210	0		29	10	S5660_210_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	210	0		29	10	S5660_210_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	210	0		29	10	S5660_210_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											90.07	50	50	50				88.55	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	210	0		29	10	S5660_210_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	210	0		29	10	S5660_210_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	211	0		29	10	S5660_211_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	211	0		29	10	S5660_211_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	211	0		29	10	S5660_211_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	211	0		29	10	S5660_211_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	211	0		29	10	S5660_211_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	211	0		29	10	S5660_211_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											76.48	50	50	50				76.39	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	211	0		29	10	S5660_211_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	211	0		29	10	S5660_211_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	212	0		29	10	S5660_212_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	212	0		29	10	S5660_212_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	212	0		29	10	S5660_212_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	212	0		29	10	S5660_212_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	212	0		29	10	S5660_212_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	212	0		29	10	S5660_212_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											93.51	50	50	50				90.64	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	212	0		29	10	S5660_212_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	212	0		29	10	S5660_212_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	213	0		29	10	S5660_213_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	213	0		29	10	S5660_213_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	213	0		29	10	S5660_213_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	213	0		29	10	S5660_213_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	213	0		29	10	S5660_213_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	213	0		29	10	S5660_213_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											92.32	50	50	50				88.19	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	213	0		29	10	S5660_213_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	213	0		29	10	S5660_213_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	214	0		29	10	S5660_214_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	214	0		29	10	S5660_214_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	214	0		29	10	S5660_214_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	214	0		29	10	S5660_214_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	214	0		29	10	S5660_214_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	214	0		29	10	S5660_214_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											90.06	50	50	50				84.47	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	214	0		29	10	S5660_214_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	214	0		29	10	S5660_214_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	215	0		29	10	S5660_215_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	215	0		29	10	S5660_215_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	215	0		29	10	S5660_215_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	215	0		29	10	S5660_215_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	215	0		29	10	S5660_215_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	215	0		29	10	S5660_215_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											88.73	50	50	50				86.69	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	215	0		29	10	S5660_215_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	215	0		29	10	S5660_215_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	216	0		29	10	S5660_216_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	216	0		29	10	S5660_216_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	216	0		29	10	S5660_216_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	216	0		29	10	S5660_216_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	216	0		29	10	S5660_216_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	216	0		29	10	S5660_216_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											98.33	49	49	49				97.50	49	49	49												49						49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	216	0		29	10	S5660_216_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	216	0		29	10	S5660_216_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	217	0		29	10	S5660_217_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	217	0		29	10	S5660_217_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	217	0		29	10	S5660_217_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	217	0		29	10	S5660_217_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5660	217	0		29	10	S5660_217_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	217	0		29	10	S5660_217_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											90.18	50	50	50				89.09	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	217	0		29	10	S5660_217_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	217	0		29	10	S5660_217_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5660	218	0		29	10	S5660_218_0	6		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	218	0		29	10	S5660_218_0	6		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	218	0		29	10	S5660_218_0	6		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	218	0		29	10	S5660_218_0	6		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											74.14	50	50	50				56.14	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	218	0		29	10	S5660_218_0	6		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	219	0		29	10	S5660_219_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	219	0		29	10	S5660_219_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	219	0		29	10	S5660_219_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	219	0		29	10	S5660_219_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											77.80	50	50	50				54.23	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	219	0		29	10	S5660_219_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	220	0		29	10	S5660_220_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	220	0		29	10	S5660_220_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	220	0		29	10	S5660_220_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	220	0		29	10	S5660_220_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											85.53	50	50	50				56.18	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	220	0		29	10	S5660_220_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	221	0		29	10	S5660_221_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	221	0		29	10	S5660_221_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	221	0		29	10	S5660_221_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	221	0		29	10	S5660_221_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											86.19	50	50	50				66.89	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	221	0		29	10	S5660_221_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	222	0		29	10	S5660_222_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	222	0		29	10	S5660_222_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	222	0		29	10	S5660_222_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	222	0		29	10	S5660_222_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											71.87	50	50	50				58.22	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	222	0		29	10	S5660_222_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	223	0		29	10	S5660_223_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	223	0		29	10	S5660_223_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	223	0		29	10	S5660_223_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	223	0		29	10	S5660_223_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											84.20	50	50	50				62.51	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	223	0		29	10	S5660_223_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	224	0		29	10	S5660_224_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	224	0		29	10	S5660_224_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	224	0		29	10	S5660_224_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	224	0		29	10	S5660_224_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											75.03	50	50	50				56.01	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	224	0		29	10	S5660_224_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	225	0		29	10	S5660_225_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	225	0		29	10	S5660_225_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	225	0		29	10	S5660_225_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	225	0		29	10	S5660_225_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											68.24	50	50	50				57.25	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	225	0		29	10	S5660_225_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	226	0		29	10	S5660_226_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	226	0		29	10	S5660_226_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	226	0		29	10	S5660_226_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	226	0		29	10	S5660_226_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											58.89	50	50	50				50.13	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	226	0		29	10	S5660_226_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	227	0		29	10	S5660_227_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	227	0		29	10	S5660_227_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	227	0		29	10	S5660_227_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	227	0		29	10	S5660_227_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											68.35	50	50	50				54.90	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	227	0		29	10	S5660_227_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	228	0		29	10	S5660_228_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	228	0		29	10	S5660_228_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	228	0		29	10	S5660_228_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	228	0		29	10	S5660_228_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											76.65	50	50	50				56.67	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	228	0		29	10	S5660_228_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	229	0		29	10	S5660_229_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	229	0		29	10	S5660_229_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	229	0		29	10	S5660_229_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	229	0		29	10	S5660_229_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											71.77	50	50	50				53.62	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	229	0		29	10	S5660_229_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	230	0		29	10	S5660_230_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	230	0		29	10	S5660_230_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	230	0		29	10	S5660_230_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	230	0		29	10	S5660_230_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											77.69	50	50	50				56.05	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	230	0		29	10	S5660_230_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	231	0		29	10	S5660_231_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	231	0		29	10	S5660_231_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	231	0		29	10	S5660_231_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	231	0		29	10	S5660_231_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											75.34	50	50	50				48.81	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	231	0		29	10	S5660_231_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	232	0		29	10	S5660_232_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	232	0		29	10	S5660_232_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	232	0		29	10	S5660_232_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	232	0		29	10	S5660_232_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											77.66	50	50	50				64.14	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	232	0		29	10	S5660_232_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											77.79	50	50	50				58.37	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	233	0		29	10	S5660_233_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	234	0		29	10	S5660_234_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	234	0		29	10	S5660_234_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	234	0		29	10	S5660_234_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	234	0		29	10	S5660_234_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											67.17	50	50	50				55.84	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	234	0		29	10	S5660_234_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	235	0		29	10	S5660_235_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	235	0		29	10	S5660_235_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	235	0		29	10	S5660_235_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	235	0		29	10	S5660_235_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											74.62	50	50	50				57.86	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	235	0		29	10	S5660_235_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	236	0		29	10	S5660_236_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	236	0		29	10	S5660_236_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	236	0		29	10	S5660_236_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	236	0		29	10	S5660_236_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											67.53	50	50	50				51.26	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	236	0		29	10	S5660_236_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	237	0		29	10	S5660_237_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	237	0		29	10	S5660_237_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	237	0		29	10	S5660_237_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	237	0		29	10	S5660_237_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											74.81	50	50	50				50.47	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	237	0		29	10	S5660_237_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	238	0		29	10	S5660_238_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	238	0		29	10	S5660_238_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	238	0		29	10	S5660_238_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	238	0		29	10	S5660_238_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											76.94	50	50	50				59.28	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	238	0		29	10	S5660_238_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	239	0		29	10	S5660_239_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	239	0		29	10	S5660_239_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	239	0		29	10	S5660_239_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	239	0		29	10	S5660_239_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											81.22	50	50	50				68.57	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	239	0		29	10	S5660_239_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	240	0		29	10	S5660_240_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	240	0		29	10	S5660_240_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	240	0		29	10	S5660_240_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	240	0		29	10	S5660_240_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											82.25	50	50	50				69.66	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	240	0		29	10	S5660_240_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	241	0		29	10	S5660_241_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	241	0		29	10	S5660_241_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	241	0		29	10	S5660_241_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	241	0		29	10	S5660_241_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											62.53	50	50	50				54.92	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	241	0		29	10	S5660_241_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	242	0		29	10	S5660_242_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	242	0		29	10	S5660_242_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	242	0		29	10	S5660_242_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	242	0		29	10	S5660_242_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											94.98	50	50	50				74.80	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	242	0		29	10	S5660_242_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	243	0		29	10	S5660_243_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	243	0		29	10	S5660_243_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	243	0		29	10	S5660_243_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	243	0		29	10	S5660_243_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											85.62	50	50	50				63.35	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	243	0		29	10	S5660_243_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	244	0		29	10	S5660_244_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	244	0		29	10	S5660_244_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	244	0		29	10	S5660_244_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	244	0		29	10	S5660_244_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											72.30	50	50	50				57.57	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	244	0		29	10	S5660_244_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	245	0		29	10	S5660_245_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	245	0		29	10	S5660_245_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	245	0		29	10	S5660_245_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	245	0		29	10	S5660_245_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											73.23	50	50	50				59.06	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	245	0		29	10	S5660_245_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	246	0		29	10	S5660_246_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	246	0		29	10	S5660_246_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	246	0		29	10	S5660_246_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	246	0		29	10	S5660_246_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											75.76	50	50	50				65.74	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	246	0		29	10	S5660_246_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	247	0		29	10	S5660_247_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	247	0		29	10	S5660_247_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	247	0		29	10	S5660_247_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	247	0		29	10	S5660_247_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											81.72	50	50	50				70.17	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	247	0		29	10	S5660_247_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	248	0		29	10	S5660_248_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	248	0		29	10	S5660_248_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	248	0		29	10	S5660_248_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	248	0		29	10	S5660_248_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											69.75	50	50	50				61.38	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	248	0		29	10	S5660_248_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	249	0		29	10	S5660_249_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	249	0		29	10	S5660_249_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	249	0		29	10	S5660_249_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	249	0		29	10	S5660_249_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											67.72	50	50	50				58.79	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	249	0		29	10	S5660_249_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	250	0		29	10	S5660_250_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	250	0		29	10	S5660_250_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	250	0		29	10	S5660_250_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	250	0		29	10	S5660_250_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											86.52	50	50	50				64.69	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	250	0		29	10	S5660_250_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	251	0		29	10	S5660_251_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	251	0		29	10	S5660_251_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	251	0		29	10	S5660_251_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	251	0		29	10	S5660_251_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											74.92	50	50	50				65.42	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	251	0		29	10	S5660_251_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	001	0		29	10	S5715_001_0	2		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					8.00		24.00													45.00						24.00				15.00				15.00			0.50	0.27				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											91.64	50		50				98.73	46		46												50						46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	2		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	002	0		29	10	S5715_002_0	2		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					2.00		6.00													27.00						6.00				9.00				9.00			0.30	0.07				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								37.00		111.00					30.00		90.00													111.00						90.00				37.00				37.00			1.23	1.00				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											81.09	45		45				77.66	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	2		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	003	0		29	10	S5715_003_0	2		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					8.00		24.00													45.00						24.00				15.00				15.00			0.50	0.27				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											98.65	40		40				86.87	38		38												40						38			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	2		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	004	0		29	10	S5715_004_0	2		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					2.00		6.00													27.00						6.00				9.00				9.00			0.30	0.07				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								37.00		111.00					30.00		90.00													111.00						90.00				37.00				37.00			1.23	1.00				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											89.19	45		45				73.66	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	2		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	005	0		29	10	S5715_005_0	2		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					8.00		24.00													45.00						24.00				15.00				15.00			0.50	0.27				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.85	42		42				87.69	40		40												42						40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	2		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	006	0		29	10	S5715_006_0	2		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					2.00		6.00													27.00						6.00				9.00				9.00			0.30	0.07				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								37.00		111.00					30.00		90.00													111.00						90.00				37.00				37.00			1.23	1.00				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											90.01	45		45				79.89	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	2		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												33		33					33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2		N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2		N	Preferred Generic	4	01	1	2	1	3		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					0.00		0.00													21.00						0.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5715	010	0		29	10	S5715_010_0	2		N	Generic	4	11	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					8.00		24.00													45.00						24.00				15.00				15.00			0.50	0.27				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											98.35	47		47				98.73	44		44												47						44			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	2		N	Specialty Tier	4	11	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31												25		25					25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													24.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					4.00		12.00													33.00						12.00				11.00				11.00			0.37	0.13				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.42	18		18				28.39	16		16												18						16			18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											58.21	47		47				50.40	45		45												47						45			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													24.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					4.00		12.00													33.00						12.00				11.00				11.00			0.37	0.13				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											21.82	14		14				19.79	12		12												14						12			14			14								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											62.92	44		44				55.63	42		42												44						42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	4		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													24.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					4.00		12.00													33.00						12.00				11.00				11.00			0.37	0.13				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											21.58	15		15				23.73	13		13												15						13			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											59.61	45		45				52.06	43		43												45						43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	2		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													24.00						3.00				8.00				8.00			0.27	0.03				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	2		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					4.00		12.00													33.00						12.00				11.00				11.00			0.37	0.13				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											22.24	15		15				21.06	13		13												15						13			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											56.29	48		48				47.93	46		46												48						46			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	018	0		29	10	S5715_018_0	2		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	1.00		3.00																			1.00		3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	018	0		29	10	S5715_018_0	2		N	Generic	4	11	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	4.00		12.00																			4.00		12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	018	0		29	10	S5715_018_0	2		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	018	0		29	10	S5715_018_0	2		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		90				1	2	30		90				30		31				76.48	35		35																		35		35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	018	0		29	10	S5715_018_0	2		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								45.00	90.00	135.00					37.00	74.00	111.00					37.00	74.00	111.00																45.00				45.00			1.50	1.23	1.23			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											96.95	38	38	38				84.20	33	33	33				33	33	33															38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											63.11	50	50	50				56.80	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	014	0		29	10	S5726_014_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	019	0		29	10	S5726_019_0	5		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	019	0		29	10	S5726_019_0	5		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5726	019	0		29	10	S5726_019_0	5		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	019	0		29	10	S5726_019_0	5		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5726	019	0		29	10	S5726_019_0	5		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											21.18	22	22	22				19.26	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	019	0		29	10	S5726_019_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											75.62	42	42	42				70.22	39	39	39				39	39	39															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5726	019	0		29	10	S5726_019_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4		N	Preferred Generic	3	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	20.00					1.00	2.00	2.00											10.00	20.00	20.00				1.00	2.00	2.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4		N	Generic	3	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					7.00	14.00	14.00											15.00	30.00	30.00				7.00	14.00	14.00				15.00				15.00			0.50	0.23		0.50	0.23	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								46.00	92.00	138.00					29.00	58.00	87.00											46.00	92.00	138.00				29.00	58.00	87.00				46.00				46.00			1.53	0.97		1.53	0.97	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.59	36	36	36				62.36	31	31	31										36	36	36				31	31	31			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	4		N	Preferred Generic	4	11	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					0.00	0.00	0.00											15.00	30.00	30.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	4		N	Preferred Generic	4	11	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	30.00					0.00	0.00	0.00											15.00	30.00	30.00				0.00	0.00	0.00				15.00				15.00			0.50	0.00		0.50	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5743	004	0		29	10	S5743_004_0	4		N	Generic	4	11	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	40.00	40.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	4		N	Generic	4	11	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					0.00	0.00	0.00											20.00	40.00	40.00				0.00	0.00	0.00				20.00				20.00			0.67	0.00		0.67	0.00	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5743	004	0		29	10	S5743_004_0	4		N	Preferred Brand	4	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											31.06	25	25	25				17.82	17	17	17										25	25	25				17	17	17			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	4		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.01	45	45	45				66.62	40	40	40										45	45	45				40	40	40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	4		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	7		N	Preferred Generic	2	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	20.00				3.00	6.00	7.50					8.00			3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	7		N	Generic	2	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	50.00				15.00	30.00	37.50					20.00			15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	7		N	Preferred Brand	2	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	7		N	Non-Preferred Drug	2	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											95.31	50	50	50				98.62	49	49	49										50	50	50				49	49	49				50		49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	7		N	Specialty Tier	2	11	1	1	5	1		010	10		010	1				30								30				29	31											790.48	25						938.03	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	6		N	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00					5.00			0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	6		N	Preferred Generic	4	01	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	12.50				0.00	0.00	0.00					5.00			0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	6		N	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	40.00				11.00	22.00	27.50					16.00			11.00			0.53	0.37		0.53	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	6		N	Generic	4	01	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		29	31								16.00	32.00	48.00					11.00	22.00	33.00											16.00	32.00	40.00				11.00	22.00	27.50					16.00			11.00			0.53	0.37		0.53	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	6		N	Preferred Brand	4	11	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	117.50				42.00	84.00	105.00					47.00			42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	6		N	Non-Preferred Drug	4	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		29	31											97.09	50	50	50				97.63	45	45	45										50	50	50				45	45	45				50		45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	6		N	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				29	31											962.78	33						1479.53	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.44	50		50				84.44	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											93.97	47		47				93.97	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											94.77	46		46				94.77	46		46										46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											89.15	47		47				89.15	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											92.13	50		50				92.13	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.28	49		49				87.28	49		49										49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											85.85	47		47				85.85	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					0.00		0.00											8.00		24.00				0.00		0.00				8.00				8.00			0.27	0.00		0.27	0.00	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.43	47		47				84.43	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											89.03	49		49				89.03	49		49										49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.56	47		47				86.56	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83	45		45				83	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											85.48	45		45				85.48	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.59	47		47				83.59	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											85.49	46		46				85.49	46		46										46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.2	45		45				87.2	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.87	47		47				84.87	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.28	50		50				91.28	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											74.33	46		46				74.33	46		46										46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.34	49		49				82.34	49		49										49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.37	49		49				87.37	49		49										49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.01	46		46				84.01	46		46										46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.19	48		48				87.19	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											89.55	50		50				89.55	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.21	50		50				91.21	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											80.6	44		44				80.6	44		44										44		44				44		44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.5	45		45				88.5	45		45										45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											85.32	48		48				85.32	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											78.54	42		42				78.54	42		42										42		42				42		42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.8	48		48				86.8	48		48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.78	49		49				82.78	49		49										49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											94.35	44		44				94.35	44		44										44		44				44		44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											94.76	47		47				94.76	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											84.58	47		47				84.58	47		47										47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3		Y	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		10.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											94.64	43		43				94.64	43		43										43		43				43		43			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6		N	Preferred Generic	4	01	1	2	1	1		110	01	110		1				30		100	1	2	30		100				30		31								10.00		25.00					2.00		5.00					2.00		5.00																10.00				2.00			0.33	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6		N	Preferred Generic	4	01	1	2	1	3		110	01	110		1				30		100	1	2	30		100				30		31								10.00		25.00					2.00		5.00					2.00		5.00																10.00				2.00			0.33	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	6		N	Generic	4	01	1	2	2	1		110	01	110		1				30		100	1	2	30		100				30		31								20.00		50.00					8.00		20.00					8.00		20.00																20.00				8.00			0.67	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6		N	Generic	4	01	1	2	2	3		110	01	110		1				30		100	1	2	30		100				30		31								20.00		50.00					8.00		20.00					8.00		20.00																20.00				8.00			0.67	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	6		N	Preferred Brand	4	11	1	2	3	1		110	01	110		1				30		100	1	2	30		100				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				30		100	1	2	30		100				30		31								100.00		250.00					90.00		225.00					90.00		225.00																100.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	6		N	Specialty Tier	4	11	1	1	5	1		110	01	110		1				30		100	1	2	30		100				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	4		N	Preferred Generic	3	01	1	2	1	1		110	01	110		1				30		100	1	2	30		100				30		31								11.00		27.50					3.00		7.50					3.00		7.50																11.00				3.00			0.37	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	4		N	Generic	3	01	1	2	2	1		110	01	110		1				30		100	1	2	30		100				30		31								20.00		50.00					6.00		15.00					6.00		15.00																20.00				6.00			0.67	0.20	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	4		N	Preferred Brand	3	11	1	2	3	1		110	01	110		1				30		100	1	2	30		100				30		31								47.00		117.50					40.00		100.00					40.00		100.00																47.00				40.00			1.57	1.33	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		110	01	110		1				30		100	1	2	30		100				30		31											76.47	50		50				67.91	48		48				48		48															50			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	4		N	Specialty Tier	3	11	1	1	5	1		110	01	110		1				30		100	1	2	30		100				30		31											1.00	27		27				1.00	27		27				27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	008	0		29	10	S5795_008_0	4		N	Preferred Generic	4	01	1	2	1	1	110		01	110		1	30		100				1	2	30		100				30		31	4.00		10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	008	0		29	10	S5795_008_0	4		N	Preferred Generic	4	01	1	2	1	3	110		01	110		1	30		100				1	2	30		100				30		31	4.00		10.00																			4.00		10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5795	008	0		29	10	S5795_008_0	4		N	Generic	4	01	1	2	2	1	110		01	110		1	30		100				1	2	30		100				30		31	10.00		25.00																			10.00		25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	008	0		29	10	S5795_008_0	4		N	Generic	4	01	1	2	2	3	110		01	110		1	30		100				1	2	30		100				30		31	10.00		25.00																			10.00		25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5795	008	0		29	10	S5795_008_0	4		N	Preferred Brand	4	11	1	2	3	1	110		01	110		1	30		100				1	2	30		100				30		31	47.00		117.50																			47.00		117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	008	0		29	10	S5795_008_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	110		01	110		1	30		100				1	2	30		100				30		31				96.09	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	008	0		29	10	S5795_008_0	4		N	Specialty Tier	4	11	1	1	5	1	110		01	110		1	30		100				1	2	30		100				30		31				1.00	27		27																		27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2		Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2		Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5805	001	0		29	10	S5805_001_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											87.00	45		45				74.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											424.00	33						278.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.2		1.57	1.2	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											95.36	41		41				95.36	41		41										41		41				41		41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		5.00				6.00				6.00			0.2	0.07		0.2	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		105.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.93	38		38				96.33	37		37										38		38				37		37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		5.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		105.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.45	36		36				95.71	35		35										36		36				35		35			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		105.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.36	37		37				94.73	36		36										37		37				36		36			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		10.00				9.00				9.00			0.3	0.13		0.3	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.86	37		37				95.22	36		36										37		37				36		36			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		7.50				7.00				7.00			0.23	0.1		0.23	0.1	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.11	40		40				98.11	40		40										40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					37.00		111.00											47.00		141.00				37.00		92.50				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											95.65	42		42				95.65	42		42										42		42				42		42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.7	35		35				97.7	35		35										35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					6.00		18.00											8.00		24.00				6.00		15.00				8.00				8.00			0.27	0.2		0.27	0.2	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	3		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		105.00				47.00				47.00			1.57	1.4		1.57	1.4	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.33	36		36				96.33	36		36										36		36				36		36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.2		1.57	1.2	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.22	37		37				98.22	37		37										37		37				37		37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					2.00		6.00											6.00		18.00				2.00		5.00				6.00				6.00			0.2	0.07		0.2	0.07	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								40.00		120.00					30.00		90.00											40.00		120.00				30.00		75.00				40.00				40.00			1.33	1.00		1.33	1.00	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											93.32	45		45				89.17	43		43										45		45				43		43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					5.00		15.00											8.00		24.00				5.00		12.50				8.00				8.00			0.27	0.17		0.27	0.17	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								42.00		126.00					35.00		105.00											42.00		126.00				35.00		87.50				42.00				42.00			1.4	1.17		1.4	1.17	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											93.04	41		41				90.77	40		40										41		41				40		40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					3.00		9.00											6.00		18.00				3.00		7.50				6.00				6.00			0.2	0.1		0.2	0.1	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								46.00		138.00					36.00		108.00											46.00		138.00				36.00		90.00				46.00				46.00			1.53	1.2		1.53	1.2	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.77	36		36				96.77	36		36										36		36				36		36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					8.00		24.00											15.00		45.00				8.00		20.00				15.00				15.00			0.5	0.27		0.5	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					43.00		129.00											47.00		141.00				43.00		107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.47	39		39				91.47	39		39										39		39				39		39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					0.00		0.00											4.00		12.00				0.00		0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					6.00		18.00											8.00		24.00				6.00		15.00				8.00				8.00			0.27	0.2		0.27	0.2	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		100.00				45.00				45.00			1.5	1.33		1.5	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											94.8	41		41				92.49	40		40										41		41				40		40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					2.00		6.00											5.00		15.00				2.00		5.00				5.00				5.00			0.17	0.07		0.17	0.07	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								46.00		138.00					35.00		105.00											46.00		138.00				35.00		87.50				46.00				46.00			1.53	1.17		1.53	1.17	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.28	37		37				97.28	37		37										37		37				37		37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					4.00		12.00											7.00		21.00				4.00		10.00				7.00				7.00			0.23	0.13		0.23	0.13	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.2		1.57	1.2	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.33	41		41				97.33	41		41										41		41				41		41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					5.00		15.00											9.00		27.00				5.00		12.50				9.00				9.00			0.3	0.17		0.3	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					38.00		114.00											45.00		135.00				38.00		95.00				45.00				45.00			1.5	1.27		1.5	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.15	38		38				94.6	37		37										38		38				37		37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		7.50				7.00				7.00			0.23	0.1		0.23	0.1	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					37.00		111.00											45.00		135.00				37.00		92.50				45.00				45.00			1.5	1.23		1.5	1.23	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.19	38		38				95.61	37		37										38		38				37		37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								11.00		33.00					5.00		15.00											11.00		33.00				5.00		12.50				11.00				11.00			0.37	0.17		0.37	0.17	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					39.00		117.00											47.00		141.00				39.00		97.50				47.00				47.00			1.57	1.3		1.57	1.3	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.01	36		36				96.26	35		35										36		36				35		35			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					38.00		114.00											47.00		141.00				38.00		95.00				47.00				47.00			1.57	1.27		1.57	1.27	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.01	35		35				97.01	35		35										35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		10.00				9.00				9.00			0.3	0.13		0.3	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					38.00		114.00											45.00		135.00				38.00		95.00				45.00				45.00			1.5	1.27		1.5	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											94.66	42		42				92.41	41		41										42		42				41		41			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		12.50				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					38.00		114.00											45.00		135.00				38.00		95.00				45.00				45.00			1.5	1.27		1.5	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.45	37		37				96.45	37		37										37		37				37		37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		7.50				7.00				7.00			0.23	0.1		0.23	0.1	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								44.00		132.00					35.00		105.00											44.00		132.00				35.00		87.50				44.00				44.00			1.47	1.17		1.47	1.17	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.03	37		37				97.03	37		37										37		37				37		37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0.00		0.03	0.00	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								6.00		18.00					3.00		9.00											6.00		18.00				3.00		7.50				6.00				6.00			0.2	0.1		0.2	0.1	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								42.00		126.00					33.00		99.00											42.00		126.00				33.00		82.50				42.00				42.00			1.4	1.1		1.4	1.1	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.7	39		39				98.7	39		39										39		39				39		39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					39.00		117.00											45.00		135.00				39.00		97.50				45.00				45.00			1.5	1.3		1.5	1.3	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											95.14	45		45				84.57	40		40										45		45				40		40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					39.00		117.00											47.00		141.00				39.00		97.50				47.00				47.00			1.57	1.3		1.57	1.3	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.81	40		40				93.87	38		38										40		40				38		38			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					0.00		0.00											4.00		12.00				0.00		0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		10.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					39.00		117.00											47.00		141.00				39.00		97.50				47.00				47.00			1.57	1.3		1.57	1.3	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											95.99	41		41				93.65	40		40										41		41				40		40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								13.00		39.00					4.00		12.00											13.00		39.00				4.00		10.00				13.00				13.00			0.43	0.13		0.43	0.13	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					40.00		120.00											47.00		141.00				40.00		100.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											99.06	38		38				96.45	37		37										38		38				37		37			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0.00		0.07	0.00	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								4.00		12.00					2.00		6.00											4.00		12.00				2.00		5.00				4.00				4.00			0.13	0.07		0.13	0.07	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								43.00		129.00					35.00		105.00											43.00		129.00				35.00		87.50				43.00				43.00			1.43	1.17		1.43	1.17	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.65	43		43				92.15	41		41										43		43				41		41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		7.50				8.00				8.00			0.27	0.1		0.27	0.1	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					39.00		117.00											45.00		135.00				39.00		97.50				45.00				45.00			1.5	1.3		1.5	1.3	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.21	35		35				97.21	35		35										35		35				35		35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.1	0.00		0.1	0.00	0.1	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		5.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					36.00		108.00											47.00		141.00				36.00		90.00				47.00				47.00			1.57	1.2		1.57	1.2	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											97.19	41		41				92.45	39		39										41		41				39		39			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								19.00		57.00					0.00		0.00											19.00		57.00				0.00		0.00				19.00				19.00			0.63	0.00		0.63	0.00	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		45.00				20.00				20.00			0.67	0.6		0.67	0.6	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		112.50				47.00				47.00			1.57	1.5		1.57	1.5	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											98.92	33		33				98.92	33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		37.50				20.00				20.00			0.67	0.5		0.67	0.5	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	2		N	Preferred Brand	2	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		112.50				47.00				47.00			1.57	1.5		1.57	1.5	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.35	46		46				94.25	45		45										46		46				45		45			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	276	0		29	10	S5810_276_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	276	0		29	10	S5810_276_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	276	0		29	10	S5810_276_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	276	0		29	10	S5810_276_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.18	49		49				78.15	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	276	0		29	10	S5810_276_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	277	0		29	10	S5810_277_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	277	0		29	10	S5810_277_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	277	0		29	10	S5810_277_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	277	0		29	10	S5810_277_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											96.87	45		45				90.41	42		42										45		45				42		42			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	277	0		29	10	S5810_277_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	278	0		29	10	S5810_278_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	278	0		29	10	S5810_278_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	278	0		29	10	S5810_278_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	278	0		29	10	S5810_278_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.54	49		49				78.46	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	278	0		29	10	S5810_278_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	279	0		29	10	S5810_279_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	279	0		29	10	S5810_279_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	279	0		29	10	S5810_279_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	279	0		29	10	S5810_279_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.42	49		49				74.93	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	279	0		29	10	S5810_279_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	280	0		29	10	S5810_280_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	280	0		29	10	S5810_280_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	280	0		29	10	S5810_280_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	280	0		29	10	S5810_280_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.89	49		49				71.05	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	280	0		29	10	S5810_280_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	281	0		29	10	S5810_281_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	281	0		29	10	S5810_281_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	281	0		29	10	S5810_281_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	281	0		29	10	S5810_281_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.38	49		49				70.61	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	281	0		29	10	S5810_281_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	282	0		29	10	S5810_282_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	282	0		29	10	S5810_282_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	282	0		29	10	S5810_282_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	282	0		29	10	S5810_282_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.29	49		49				71.39	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	282	0		29	10	S5810_282_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	283	0		29	10	S5810_283_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	283	0		29	10	S5810_283_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	283	0		29	10	S5810_283_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	283	0		29	10	S5810_283_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.83	49		49				74.43	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	283	0		29	10	S5810_283_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	284	0		29	10	S5810_284_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	284	0		29	10	S5810_284_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	284	0		29	10	S5810_284_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	284	0		29	10	S5810_284_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.15	49		49				73.84	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	284	0		29	10	S5810_284_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	285	0		29	10	S5810_285_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	285	0		29	10	S5810_285_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	285	0		29	10	S5810_285_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	285	0		29	10	S5810_285_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											87.74	49		49				75.21	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	285	0		29	10	S5810_285_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	286	0		29	10	S5810_286_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	286	0		29	10	S5810_286_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	286	0		29	10	S5810_286_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	286	0		29	10	S5810_286_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											91.52	49		49				78.45	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	286	0		29	10	S5810_286_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	287	0		29	10	S5810_287_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	287	0		29	10	S5810_287_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	287	0		29	10	S5810_287_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	287	0		29	10	S5810_287_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											80.85	49		49				69.3	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	287	0		29	10	S5810_287_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	288	0		29	10	S5810_288_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	288	0		29	10	S5810_288_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	288	0		29	10	S5810_288_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	288	0		29	10	S5810_288_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											78.4	49		49				67.2	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	288	0		29	10	S5810_288_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	289	0		29	10	S5810_289_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	289	0		29	10	S5810_289_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	289	0		29	10	S5810_289_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	289	0		29	10	S5810_289_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.99	49		49				71.14	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	289	0		29	10	S5810_289_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	290	0		29	10	S5810_290_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	290	0		29	10	S5810_290_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	290	0		29	10	S5810_290_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	290	0		29	10	S5810_290_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.85	49		49				71.01	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	290	0		29	10	S5810_290_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	291	0		29	10	S5810_291_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	291	0		29	10	S5810_291_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	291	0		29	10	S5810_291_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	291	0		29	10	S5810_291_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.7	49		49				70.88	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	291	0		29	10	S5810_291_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	292	0		29	10	S5810_292_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	292	0		29	10	S5810_292_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	292	0		29	10	S5810_292_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	292	0		29	10	S5810_292_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											90.85	49		49				77.87	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	292	0		29	10	S5810_292_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	293	0		29	10	S5810_293_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	293	0		29	10	S5810_293_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	293	0		29	10	S5810_293_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	293	0		29	10	S5810_293_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.33	49		49				74	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	293	0		29	10	S5810_293_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	294	0		29	10	S5810_294_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	294	0		29	10	S5810_294_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	294	0		29	10	S5810_294_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	294	0		29	10	S5810_294_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.59	49		49				61.36	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	294	0		29	10	S5810_294_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	295	0		29	10	S5810_295_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	295	0		29	10	S5810_295_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	295	0		29	10	S5810_295_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	295	0		29	10	S5810_295_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											94.65	47		47				84.58	42		42										47		47				42		42			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	295	0		29	10	S5810_295_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	296	0		29	10	S5810_296_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	296	0		29	10	S5810_296_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	296	0		29	10	S5810_296_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	296	0		29	10	S5810_296_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											77.23	49		49				66.19	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	296	0		29	10	S5810_296_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	297	0		29	10	S5810_297_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	297	0		29	10	S5810_297_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	297	0		29	10	S5810_297_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	297	0		29	10	S5810_297_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											72.75	49		49				62.36	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	297	0		29	10	S5810_297_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	298	0		29	10	S5810_298_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	298	0		29	10	S5810_298_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	298	0		29	10	S5810_298_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	298	0		29	10	S5810_298_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.15	49		49				75.56	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	298	0		29	10	S5810_298_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	299	0		29	10	S5810_299_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	299	0		29	10	S5810_299_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	299	0		29	10	S5810_299_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	299	0		29	10	S5810_299_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											86.19	49		49				73.87	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	299	0		29	10	S5810_299_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	300	0		29	10	S5810_300_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	300	0		29	10	S5810_300_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	300	0		29	10	S5810_300_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	300	0		29	10	S5810_300_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											80.01	49		49				68.58	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	300	0		29	10	S5810_300_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	301	0		29	10	S5810_301_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	301	0		29	10	S5810_301_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	301	0		29	10	S5810_301_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	301	0		29	10	S5810_301_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											64.91	49		49				55.64	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	301	0		29	10	S5810_301_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	302	0		29	10	S5810_302_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	302	0		29	10	S5810_302_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	302	0		29	10	S5810_302_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	302	0		29	10	S5810_302_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											68.59	49		49				58.79	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	302	0		29	10	S5810_302_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	303	0		29	10	S5810_303_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	303	0		29	10	S5810_303_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	303	0		29	10	S5810_303_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	303	0		29	10	S5810_303_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											83.54	49		49				71.61	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	303	0		29	10	S5810_303_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	304	0		29	10	S5810_304_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	304	0		29	10	S5810_304_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	304	0		29	10	S5810_304_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	304	0		29	10	S5810_304_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.68	49		49				61.44	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	304	0		29	10	S5810_304_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	305	0		29	10	S5810_305_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	305	0		29	10	S5810_305_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	305	0		29	10	S5810_305_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	305	0		29	10	S5810_305_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											68.73	49		49				58.91	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	305	0		29	10	S5810_305_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	306	0		29	10	S5810_306_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	306	0		29	10	S5810_306_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	306	0		29	10	S5810_306_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	306	0		29	10	S5810_306_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											70.95	49		49				60.81	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	306	0		29	10	S5810_306_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	307	0		29	10	S5810_307_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	307	0		29	10	S5810_307_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	307	0		29	10	S5810_307_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	307	0		29	10	S5810_307_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											74.05	49		49				63.47	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	307	0		29	10	S5810_307_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	308	0		29	10	S5810_308_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	308	0		29	10	S5810_308_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	308	0		29	10	S5810_308_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	308	0		29	10	S5810_308_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.78	49		49				76.10	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	308	0		29	10	S5810_308_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	309	0		29	10	S5810_309_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					0.00		0.00											15.00		45.00				0.00		0.00				15.00				15.00			0.5	0.00		0.5	0.00	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	309	0		29	10	S5810_309_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					3.00		9.00											20.00		60.00				3.00		7.50				20.00				20.00			0.67	0.1		0.67	0.1	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	309	0		29	10	S5810_309_0	2		N	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		117.50				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	309	0		29	10	S5810_309_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											82.70	49		49				70.89	42		42										49		49				42		42			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	309	0		29	10	S5810_309_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	001	0		29	10	S5820_001_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	45		45				57.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											440.00	33						466.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	002	0		29	10	S5820_002_0	3	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				74.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	3	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											481.00	33						480.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	003	0		29	10	S5820_003_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											89.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											495.00	33						448.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	004	0		29	10	S5820_004_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											452.00	33						532.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	005	0		29	10	S5820_005_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				58.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											551.00	33						445.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	006	0		29	10	S5820_006_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				63.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											388.00	33						418.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	007	0		29	10	S5820_007_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											80.00	45		45				64.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											353.00	33						607.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	008	0		29	10	S5820_008_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											86.00	45		45				67.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											532.00	33						388.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	009	0		29	10	S5820_009_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											575.00	33						526.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	010	0		29	10	S5820_010_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											489.00	33						279.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	011	0		29	10	S5820_011_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											427.00	33						440.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	012	0		29	10	S5820_012_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	45		45				59.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											399.00	33						507.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	013	0		29	10	S5820_013_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											433.00	33						382.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	014	0		29	10	S5820_014_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											83.00	45		45				61.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											379.00	33						343.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	015	0		29	10	S5820_015_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	45		45				62.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											430.00	33						414.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	016	0		29	10	S5820_016_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											520.00	33						435.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	017	0		29	10	S5820_017_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	45		45				67.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											480.00	33						432.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	018	0		29	10	S5820_018_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											87.00	45		45				55.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											535.00	33						566.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	019	0		29	10	S5820_019_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											89.00	45		45				57.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											588.00	33						484.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	020	0		29	10	S5820_020_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											86.00	45		45				68.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											450.00	33						524.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	021	0		29	10	S5820_021_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											80.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											510.00	33						593.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	022	0		29	10	S5820_022_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											84.00	45		45				60.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											459.00	33						280.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	023	0		29	10	S5820_023_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											87.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											456.00	33						429.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	024	0		29	10	S5820_024_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	45		45				58.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											505.00	33						430.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	Y	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	Y	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	Y	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	025	0		29	10	S5820_025_0	3	Y	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	Y	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	45		45				63.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	3	Y	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											439.00	33						408.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	026	0		29	10	S5820_026_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											83.00	45		45				69.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											434.00	33						303.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	027	0		29	10	S5820_027_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											479.00	33						392.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	028	0		29	10	S5820_028_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											80.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											271.00	33						265.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	029	0		29	10	S5820_029_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	45		45				58.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											479.00	33						384.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	Y	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	Y	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	Y	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	030	0		29	10	S5820_030_0	3	Y	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	Y	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											90.00	45		45				62.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	3	Y	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											483.00	33						281.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	031	0		29	10	S5820_031_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											80.00	45		45				76.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											455.00	33						441.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	032	0		29	10	S5820_032_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											84.00	45		45				72.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											441.00	33						219.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	N	Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					5.00		15.00													45.00						0.00				15.00				15.00			0.50	0.16				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	N	Y	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	N	Y	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5820	033	0		29	10	S5820_033_0	2	N	Y	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					45.00		135.00													141.00						120.00				47.00				47.00			1.56	1.50				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	N	Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											78.00	45		45				64.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	2	N	Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											387.00	33						617.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	N	N	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	1.00		3.00																					3.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	N	N	Generic	2	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	N	N	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		105.00																					105.00																35.00				35.00		1.16						1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				66.00	42		42																				42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	2	N	N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				301.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	N	N	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	1.00		3.00																					3.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	N	N	Generic	2	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	14.00		42.00																					42.00																14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	N	N	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	38.00		114.00																					114.00																38.00				38.00		1.26						1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				69.00	40		40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	2	N	N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				275.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	N	N	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	1.00		3.00																					3.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	N	N	Generic	2	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	16.00		48.00																					48.00																16.00				16.00		0.53						0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	N	N	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	37.00		111.00																					111.00																37.00				37.00		1.23						1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	N	N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				80.00	43		43																				43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	3	N	N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				375.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								34.00		102.00					29.00		87.00													102.00						87.00				34.00				34.00			1.13	0.96				1.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	50		50				63.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											357.00	25						225.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	N	N	Preferred Generic	2	01	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	1.00		3.00																					3.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	N	N	Generic	2	01	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	18.00		54.00																					54.00																18.00				18.00		0.60						0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	N	N	Preferred Brand	2	11	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	39.00		117.00																					117.00																39.00				39.00		1.30						1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				77.00	44		44																				44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	2	N	N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				219.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	5		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	5		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	5		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	25		25				30.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	5		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	40		40				62.00	35		35										40		40				35		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	5		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	23		23				32.00	20		20										23		23				20		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	39		39				67.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	25		25				34.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	38		38				62.00	33		33										38		38				33		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	24		24				32.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	40		40				61.00	35		35										40		40				35		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	25		25				29.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											66.00	41		41				53.00	33		33										41		41				33		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	25		25				29.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	40		40				58.00	34		34										40		40				34		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	24		24				32.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	42		42				52.00	32		32										42		42				32		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	3		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	24		24				31.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	39		39				65.00	34		34										39		39				34		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	24		24				28.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	40		40				63.00	35		35										40		40				35		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	25		25				34.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	45		45				64.00	35		35										45		45				35		30			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	25		25				31.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	39		39				66.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	24		24				33.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	39		39				70.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	24		24				30.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	48		48				57.00	34		34										48		48				34		30			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	22		22				36.00	20		20										22		22				20		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	38		38				68.00	32		32										38		38				32		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	25		25				35.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	43		43				82.00	35		35										43		43				35		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	25		25				36.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	46		46				62.00	35		35										46		46				35		30			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	22		22				34.00	20		20										22		22				20		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	39		39				70.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	24		24				33.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	40		40				66.00	35		35										40		40				35		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	24		24				33.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	37		37				70.00	35		35										37		37				35		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	25		25				28.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				48.00	34		34										50		50				34		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	25		25				30.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	40		40				64.00	35		35										40		40				35		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	24		24				31.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	38		38				66.00	35		35										38		38				35		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				26.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	49		49				48.00	35		35										49		49				35		30			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	24		24				31.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	43		43				59.00	35		35										43		43				35		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	24		24				31.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											66.00	39		39				60.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	25		25				29.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	36		36				63.00	35		35										36		36				35		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	25		25				28.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											66.00	45		45				50.00	34		34										45		45				34		30			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											41.00	25		25				33.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	36		36				66.00	35		35										36		36				35		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	24		24				32.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	42		42				67.00	34		34										42		42				34		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	24		24				32.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	42		42				65.00	35		35										42		42				35		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	3		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	24		24				28.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	38		38				53.00	31		31										38		38				31		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	3		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	3		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	3		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											42.00	25		25				34.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											85.00	43		43				69.00	35		35										43		43				35		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2		N	Preferred Generic	2	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								1.00		3.00					0.00		0.00											1.00		3.00				0.00		0.00				1.00				1.00			0.03	0		0.03	0	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2		N	Generic	2	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					1.00		3.00											2.00		6.00				1.00		0.00				2.00				2.00			0.07	0.03		0.07	0.03	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2		N	Preferred Brand	2	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	25		25				29.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	39		39				67.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	5		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	5		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				73.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				78.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				75.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				80.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				80.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				79.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	50		50				77.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				69.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				78.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				79.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				77.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				75.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				76.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				77.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				80.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				80.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				79.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				78.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				75.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				78.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	50		50				87.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				79.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				74.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				68.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				73.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	50		50				77.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	50		50				77.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				88.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	50		50				82.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				76.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				87.00	49		49										50		50				49		49			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	48		48				97.00	47		47										48		48				47		47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								5.00		15.00					1.00		3.00											5.00		15.00				1.00		0.00				5.00				5.00			0.17	0.03		0.17	0.03	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Generic	4	11	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					4.00		12.00											10.00		30.00				4.00		0.00				10.00				10.00			0.33	0.13		0.33	0.13	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Preferred Brand	4	11	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	48		48				97.00	47		47										48		48				47		47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	5		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	5		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	5		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	22		22				32.00	19		19										22		22				19		19			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	5		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	50		50				66.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	181	0		29	10	S5884_181_0	5		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	23		23				29.00	17		17										23		23				17		17			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				65.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	182	0		29	10	S5884_182_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											41.00	23		23				28.00	16		16										23		23				16		16			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											97.00	50		50				66.00	34		34										50		50				34		34			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	183	0		29	10	S5884_183_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	22		22				32.00	19		19										22		22				19		19			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	50		50				66.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	184	0		29	10	S5884_184_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	23		23				30.00	19		19										23		23				19		19			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				64.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	185	0		29	10	S5884_185_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	22		22				31.00	19		19										22		22				19		19			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				65.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	186	0		29	10	S5884_186_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	22		22				26.00	17		17										22		22				17		17			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	50		50				66.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	187	0		29	10	S5884_187_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	22		22				27.00	18		18										22		22				18		18			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											95.00	50		50				67.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	188	0		29	10	S5884_188_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	23		23				23.00	16		16										23		23				16		16			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	50		50				66.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	189	0		29	10	S5884_189_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	22		22				24.00	16		16										22		22				16		16			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	50		50				63.00	34		34										50		50				34		34			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	190	0		29	10	S5884_190_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	22		22				23.00	16		16										22		22				16		16			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											90.00	50		50				58.00	32		32										50		50				32		32			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	191	0		29	10	S5884_191_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	22		22				29.00	18		18										22		22				18		18			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				65.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	192	0		29	10	S5884_192_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	23		23				30.00	19		19										23		23				19		19			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	50		50				62.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	193	0		29	10	S5884_193_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	22		22				28.00	19		19										22		22				19		19			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											85.00	47		47				63.00	35		35										47		47				35		35			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	194	0		29	10	S5884_194_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	23		23				29.00	19		19										23		23				19		19			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	50		50				62.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	195	0		29	10	S5884_195_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	23		23				28.00	18		18										23		23				18		18			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											91.00	50		50				63.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	196	0		29	10	S5884_196_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	23		23				23.00	16		16										23		23				16		16			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				62.00	34		34										50		50				34		34			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	197	0		29	10	S5884_197_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	24		24				24.00	18		18										24		24				18		18			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											87.00	50		50				61.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	198	0		29	10	S5884_198_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	23		23				21.00	16		16										23		23				16		16			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	40		40				45.00	26		26										40		40				26		26			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	199	0		29	10	S5884_199_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	22		22				24.00	17		17										22		22				17		17			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	50		50				62.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	200	0		29	10	S5884_200_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											34.00	22		22				27.00	18		18										22		22				18		18			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	46		46				67.00	35		35										46		46				35		35			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	201	0		29	10	S5884_201_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	22		22				23.00	16		16										22		22				16		16			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											95.00	50		50				62.00	33		33										50		50				33		33			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	202	0		29	10	S5884_202_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	22		22				25.00	17		17										22		22				17		17			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	50		50				65.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	203	0		29	10	S5884_203_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											36.00	23		23				25.00	16		16										23		23				16		16			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				65.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	204	0		29	10	S5884_204_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											38.00	22		22				33.00	19		19										22		22				19		19			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	50		50				65.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	205	0		29	10	S5884_205_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											45.00	24		24				34.00	18		18										24		24				18		18			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	46		46				71.00	35		35										46		46				35		35			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	206	0		29	10	S5884_206_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											40.00	24		24				32.00	19		19										24		24				19		19			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	49		49				66.00	35		35										49		49				35		35			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	207	0		29	10	S5884_207_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	23		23				31.00	18		18										23		23				18		18			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	48		48				68.00	35		35										48		48				35		35			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	208	0		29	10	S5884_208_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											41.00	23		23				32.00	18		18										23		23				18		18			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											92.00	50		50				65.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	209	0		29	10	S5884_209_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											35.00	22		22				30.00	19		19										22		22				19		19			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											89.00	47		47				66.00	35		35										47		47				35		35			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	210	0		29	10	S5884_210_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	20		20				31.00	17		17										20		20				17		17			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											97.00	50		50				68.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	211	0		29	10	S5884_211_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											44.00	22		22				36.00	18		18										22		22				18		18			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											96.00	46		46				73.00	35		35										46		46				35		35			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	212	0		29	10	S5884_212_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	2		N	Preferred Generic	4	11	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		3.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	2		N	Generic	4	11	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		12.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	2		N	Preferred Brand	4	11	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											43.00	23		23				34.00	18		18										23		23				18		18			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	2		N	Non-Preferred Drug	4	11	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											91.00	42		42				75.00	35		35										42		42				35		35			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	213	0		29	10	S5884_213_0	2		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	7		N	Preferred Generic	3	01	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	7		N	Generic	3	01	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	11.00		33.00																			11.00		33.00																11.00				11.00		0.35			0.35			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	7		N	Preferred Brand	3	11	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.52			1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	7		N	Non-Preferred Drug	3	11	1	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				87.97	50		50																		50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	7		N	Specialty Tier	3	11	1	1	5	1	010		01	010		1	31								31						31		31				864.68	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5		Y	Preferred Generic	4	01	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5		Y	Preferred Generic	4	01	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								13.00		39.00					3.00		9.00					3.00		9.00																13.00				3.00			0.42	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	5		Y	Generic	4	01	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5		Y	Generic	4	01	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					10.00		30.00					10.00		30.00																20.00				10.00			0.65	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	5		Y	Preferred Brand	4	11	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5		Y	Non-Preferred Drug	4	11	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01	010		1				31					31						31		31											887.15	33						887.15	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					3.00	6.00	6.00					3.00	6.00	6.00																10.00				10.00			0.33	0.10	0.10			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	34.00					10.00	20.00	20.00					10.00	20.00	20.00																17.00				17.00			0.57	0.33	0.33			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					40.00	80.00	100.00					40.00	80.00	100.00																47.00				47.00			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											67.37	35	35	35				57.74	30	30	30				30	30	30															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		31											767.23	27						767.23	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5916	002	0		29	10	S5916_002_0	5		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	117.50																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.99	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5916	002	0		29	10	S5916_002_0	5		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				937.73	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								36.00		108.00					31.00		93.00													108.00						93.00				36.00				36.00			1.20	1.03				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											67.00	40		40				71.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											326.00	25						353.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								33.00		99.00					28.00		84.00													99.00						84.00				33.00				33.00			1.10	0.93				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	40		40				76.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											293.00	25						245.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								36.00		108.00					31.00		93.00													108.00						93.00				36.00				36.00			1.20	1.03				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	40		40				68.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											239.00	25						268.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								38.00		114.00					33.00		99.00													114.00						99.00				38.00				38.00			1.26	1.10				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	40		40				64.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											271.00	25						263.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								39.00		117.00					34.00		102.00													117.00						102.00				39.00				39.00			1.30	1.13				1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											79.00	40		40				69.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	3	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											233.00	25						329.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								39.00		117.00					34.00		102.00													117.00						102.00				39.00				39.00			1.30	1.13				1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	40		40				71.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											306.00	25						311.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					10.00		30.00													45.00						30.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					40.00		120.00													135.00						120.00				45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											82.00	40		40				66.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											270.00	25						300.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								42.00		126.00					37.00		111.00													126.00						111.00				42.00				42.00			1.40	1.23				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	40		40				61.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											343.00	25						246.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								44.00		132.00					39.00		117.00													132.00						117.00				44.00				44.00			1.46	1.30				1.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	40		40				70.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											278.00	25						245.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								41.00		123.00					36.00		108.00													123.00						108.00				41.00				41.00			1.36	1.20				1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	40		40				68.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											259.00	25						291.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								33.00		99.00					28.00		84.00													99.00						84.00				33.00				33.00			1.10	0.93				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											72.00	40		40				70.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											257.00	25						204.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								16.00		48.00					11.00		33.00													48.00						33.00				16.00				16.00			0.53	0.36				0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					40.00		120.00													135.00						120.00				45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	40		40				63.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											235.00	25						312.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								40.00		120.00					35.00		105.00													120.00						105.00				40.00				40.00			1.33	1.16				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	40		40				72.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											288.00	25						226.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								36.00		108.00					31.00		93.00													108.00						93.00				36.00				36.00			1.20	1.03				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	40		40				60.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											339.00	25						253.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								42.00		126.00					37.00		111.00													126.00						111.00				42.00				42.00			1.40	1.23				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											70.00	40		40				70.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											232.00	25						294.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					40.00		120.00													135.00						120.00				45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											67.00	40		40				56.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											262.00	25						167.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								46.00		138.00					41.00		123.00													138.00						123.00				46.00				46.00			1.53	1.36				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	40		40				63.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											300.00	25						291.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								42.00		126.00					37.00		111.00													126.00						111.00				42.00				42.00			1.40	1.23				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	40		40				70.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											296.00	25						302.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								35.00		105.00					30.00		90.00													105.00						90.00				35.00				35.00			1.16	1.00				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											86.00	40		40				74.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	3	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											285.00	25						312.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								43.00		129.00					38.00		114.00													129.00						114.00				43.00				43.00			1.43	1.26				1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											73.00	40		40				69.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											284.00	25						228.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								36.00		108.00					31.00		93.00													108.00						93.00				36.00				36.00			1.20	1.03				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	40		40				79.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											267.00	25						257.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								40.00		120.00					35.00		105.00													120.00						105.00				40.00				40.00			1.33	1.16				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	40		40				73.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											333.00	25						279.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								39.00		117.00					34.00		102.00													117.00						102.00				39.00				39.00			1.30	1.13				1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											67.00	40		40				64.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											244.00	25						234.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	Y	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	Y	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								12.00		36.00					7.00		21.00													36.00						21.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	Y	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								40.00		120.00					35.00		105.00													120.00						105.00				40.00				40.00			1.33	1.16				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	Y	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											65.00	40		40				66.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	3	Y	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											247.00	25						345.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								41.00		123.00					36.00		108.00													123.00						108.00				41.00				41.00			1.36	1.20				1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	40		40				72.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											298.00	25						180.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								41.00		123.00					36.00		108.00													123.00						108.00				41.00				41.00			1.36	1.20				1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	40		40				75.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											222.00	25						292.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								37.00		111.00					32.00		96.00													111.00						96.00				37.00				37.00			1.23	1.06				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											68.00	40		40				59.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											255.00	25						259.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	Y	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	Y	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	Y	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								40.00		120.00					35.00		105.00													120.00						105.00				40.00				40.00			1.33	1.16				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	Y	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	40		40				65.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	3	Y	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											293.00	25						282.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								10.00		30.00					5.00		15.00													30.00						15.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								30.00		90.00					25.00		75.00													90.00						75.00				30.00				30.00			1.00	0.83				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	40		40				92.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											265.00	25						297.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								36.00		108.00					31.00		93.00													108.00						93.00				36.00				36.00			1.20	1.03				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											66.00	40		40				64.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											239.00	25						292.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								11.00		33.00					6.00		18.00													33.00						18.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								38.00		114.00					33.00		99.00													114.00						99.00				38.00				38.00			1.26	1.10				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											63.00	40		40				57.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											293.00	25						280.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								36.00		108.00					31.00		93.00													108.00						93.00				36.00				36.00			1.20	1.03				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											77.00	40		40				74.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											273.00	25						296.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								17.00		51.00					12.00		36.00													51.00						36.00				17.00				17.00			0.56	0.40				0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								45.00		135.00					40.00		120.00													135.00						120.00				45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	40		40				66.00	40		40												40						40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	3	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											323.00	25						279.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	N	N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								6.00		18.00					1.00		3.00													18.00						3.00				6.00				6.00			0.20	0.03				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	N	N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	2	2						90	30		31								13.00		39.00					8.00		24.00													39.00						24.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	N	N	Preferred Brand	2	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								31.00		93.00					26.00		78.00													93.00						78.00				31.00				31.00			1.03	0.86				1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	N	N	Non-Preferred Drug	2	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											75.00	38		38				88.00	38		38												38						38			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	N	N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											285.00	25						208.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	382	0		29	10	S5921_382_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											93.00	45		45				80.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											409.00	25						261.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	383	0		29	10	S5921_383_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				81.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											266.00	25						338.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	384	0		29	10	S5921_384_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	384	0		29	10	S5921_384_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											209.00	25						311.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	385	0		29	10	S5921_385_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	385	0		29	10	S5921_385_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											133.00	25						255.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	386	0		29	10	S5921_386_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	386	0		29	10	S5921_386_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	386	0		29	10	S5921_386_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	386	0		29	10	S5921_386_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	386	0		29	10	S5921_386_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											89.00	45		45				79.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	386	0		29	10	S5921_386_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											291.00	25						342.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	387	0		29	10	S5921_387_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											91.00	45		45				73.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	387	0		29	10	S5921_387_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											345.00	25						250.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	388	0		29	10	S5921_388_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											87.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	388	0		29	10	S5921_388_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											370.00	25						236.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	389	0		29	10	S5921_389_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	389	0		29	10	S5921_389_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	389	0		29	10	S5921_389_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	389	0		29	10	S5921_389_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	389	0		29	10	S5921_389_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											80.00	45		45				77.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	389	0		29	10	S5921_389_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											276.00	25						279.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	390	0		29	10	S5921_390_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	45		45				77.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	390	0		29	10	S5921_390_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											306.00	25						295.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	391	0		29	10	S5921_391_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											91.00	45		45				74.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	391	0		29	10	S5921_391_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											331.00	25						328.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	392	0		29	10	S5921_392_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											99.00	45		45				81.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	392	0		29	10	S5921_392_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											209.00	25						260.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	393	0		29	10	S5921_393_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				73.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	393	0		29	10	S5921_393_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											139.00	25						237.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	394	0		29	10	S5921_394_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											55.00	45		45				74.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	394	0		29	10	S5921_394_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											231.00	25						173.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	395	0		29	10	S5921_395_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											96.00	45		45				82.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	395	0		29	10	S5921_395_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											301.00	25						264.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	396	0		29	10	S5921_396_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											97.00	45		45				74.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	396	0		29	10	S5921_396_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											315.00	25						235.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	397	0		29	10	S5921_397_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											71.00	45		45				66.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	397	0		29	10	S5921_397_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											183.00	25						307.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	398	0		29	10	S5921_398_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											87.00	45		45				79.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	398	0		29	10	S5921_398_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											382.00	25						247.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	399	0		29	10	S5921_399_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											69.00	45		45				70.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	399	0		29	10	S5921_399_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											351.00	25						330.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	400	0		29	10	S5921_400_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											81.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	400	0		29	10	S5921_400_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											400.00	25						243.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	401	0		29	10	S5921_401_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											99.00	45		45				80.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	401	0		29	10	S5921_401_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											226.00	25						337.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	402	0		29	10	S5921_402_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				82.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	402	0		29	10	S5921_402_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											412.00	25						195.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	403	0		29	10	S5921_403_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											100.00	45		45				73.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	403	0		29	10	S5921_403_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											256.00	25						307.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	404	0		29	10	S5921_404_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											93.00	45		45				81.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	404	0		29	10	S5921_404_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											384.00	25						324.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	405	0		29	10	S5921_405_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											76.00	45		45				67.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	405	0		29	10	S5921_405_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											406.00	25						374.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	406	0		29	10	S5921_406_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											88.00	45		45				67.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	406	0		29	10	S5921_406_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											235.00	25						227.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Y	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Y	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Y	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	407	0		29	10	S5921_407_0	2	Y	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Y	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											83.00	45		45				82.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	407	0		29	10	S5921_407_0	2	Y	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											0.00	25						288.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	408	0		29	10	S5921_408_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											93.00	45		45				77.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	408	0		29	10	S5921_408_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											409.00	25						318.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	409	0		29	10	S5921_409_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											86.00	45		45				78.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	409	0		29	10	S5921_409_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											180.00	25						270.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	410	0		29	10	S5921_410_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											85.00	45		45				96.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	410	0		29	10	S5921_410_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											347.00	25						271.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	411	0		29	10	S5921_411_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											82.00	45		45				71.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	411	0		29	10	S5921_411_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											160.00	25						217.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	2	Y	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	2	Y	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	2	Y	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	412	0		29	10	S5921_412_0	2	Y	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	2	Y	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											83.00	45		45				67.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	412	0		29	10	S5921_412_0	2	Y	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											125.00	25						120.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	413	0		29	10	S5921_413_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											96.00	45		45				80.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	413	0		29	10	S5921_413_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											345.00	25						413.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	414	0		29	10	S5921_414_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											74.00	45		45				87.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	414	0		29	10	S5921_414_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											128.00	25						341.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	N	N	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	N	N	Generic	4	01	3	2	2	1		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	N	N	Generic	4	01	3	2	2	3		110	01		100	1				30		90	2	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				20.00			0.66	0.20				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		2
S5921	415	0		29	10	S5921_415_0	2	N	N	Preferred Brand	4	11	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					40.00		120.00													141.00						120.00				47.00				47.00			1.56	1.33				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	N	N	Non-Preferred Drug	4	11	1	1	4	1		110	01		100	1				30		90	2	2						90	30		31											86.00	45		45				94.00	40		40												45						40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	415	0		29	10	S5921_415_0	2	N	N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											295.00	25						278.00	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3		N	Preferred Generic	3	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	12.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3		N	Generic	3	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3		N	Preferred Brand	3	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	47.00	94.00	141.00																			47.00	94.00	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3		N	Non-Preferred Drug	3	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				64.04	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3		N	Specialty Tier	3	11	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					27	27	27																		27	27	27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	3		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	3		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	50.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				45.45	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3		N	Specialty Tier	4	11	1	1	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5960	167	0		29	10	S5960_167_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5960	167	0		29	10	S5960_167_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5960	167	0		29	10	S5960_167_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5960	167	0		29	10	S5960_167_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											99.75	32	32	32				93.52	30	30	30				30	30	30															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5960	167	0		29	10	S5960_167_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	003	0		29	10	S5966_003_0	5		N	Preferred Generic	2	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					0.00	0.00	0.00																7.00				7.00			0.23	0.07	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	003	0		29	10	S5966_003_0	5		N	Generic	2	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					12.00	24.00	30.00																17.00				17.00			0.57	0.40	.40			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	003	0		29	10	S5966_003_0	5		N	Preferred Brand	2	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					40.00	80.00	120.00																45.00				45.00			1.50	1.33	1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	003	0		29	10	S5966_003_0	5		N	Non-Preferred Drug	2	11	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											63.80	33	33	33				63.80	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	003	0		29	10	S5966_003_0	5		N	Specialty Tier	2	11	1	1	5	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	004	0		29	10	S5966_004_0	6		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	004	0		29	10	S5966_004_0	6		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					0.00	0.00	0.00					0.00	0.00	0.00																15.00				15.00			0.50	0.00	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	004	0		29	10	S5966_004_0	6		N	Preferred Brand	4	10	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					35.00	70.00	105.00					35.00	70.00	105.00																47.00				47.00			1.57	1.17	1.17			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	004	0		29	10	S5966_004_0	6		N	Non-Preferred Drug	4	11	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5966	004	0		29	10	S5966_004_0	6		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		31												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2		N	Preferred Generic	3	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					1.00	2.00	3.00													30.00						0.00				10.00				10.00			0.33	0.03				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	004	0		29	10	S5983_004_0	2		N	Generic	3	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								12.00	24.00	36.00					3.00	6.00	9.00													36.00						0.00				12.00				12.00			0.40	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	004	0		29	10	S5983_004_0	2		N	Preferred Brand	3	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								26.00	52.00	78.00					20.00	40.00	60.00													78.00						60.00				26.00				26.00			0.87	0.67				0.84	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	004	0		29	10	S5983_004_0	2		N	Non-Preferred Drug	3	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											85.33	50	50	50				75.07	46	46	46												50						46			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	004	0		29	10	S5983_004_0	2		N	Specialty Tier	3	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	004	0		29	10	S5983_004_0	2		N	Select Care Drugs	3	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								6.00	12.00	18.00					0.00	0.00	0.00													18.00						0.00				6.00				6.00			0.20	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	006	0		29	10	S5983_006_0	1		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	006	0		29	10	S5983_006_0	1		Y	Preferred Generic	4	01	1	2	1	3		111	01		100	1				30	60	90	1	2						90	30		31								10.00	20.00	30.00					2.00	4.00	6.00													30.00						0.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5983	006	0		29	10	S5983_006_0	1		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	006	0		29	10	S5983_006_0	1		Y	Generic	4	01	1	2	2	3		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						4.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5983	006	0		29	10	S5983_006_0	1		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					42.00	84.00	126.00													141.00						126.00				47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	006	0		29	10	S5983_006_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											88.58	50	50	50				87.88	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	006	0		29	10	S5983_006_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	006	0		29	10	S5983_006_0	1		Y	Select Care Drugs	4	11	1	2	6	1		111	01		100	1				30	60	90	1	2						90	30		31								11.00	22.00	33.00					0.00	0.00	0.00													33.00						0.00				11.00				11.00			0.37	0.00				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5983	007	0		29	10	S5983_007_0	5		Y	Preferred Generic	4	01	1	2	1	1		111	01		100	1				30	60	90	1	2						90	30		31								19.00	38.00	57.00					2.00	4.00	6.00													57.00						0.00				19.00				19.00			0.63	0.07				0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	007	0		29	10	S5983_007_0	5		Y	Generic	4	01	1	2	2	1		111	01		100	1				30	60	90	2	2						90	30		31								20.00	40.00	60.00					7.00	14.00	21.00													60.00						0.00				20.00				20.00			0.67	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	007	0		29	10	S5983_007_0	5		Y	Preferred Brand	4	11	1	2	3	1		111	01		100	1				30	60	90	2	2						90	30		31								47.00	94.00	141.00					35.00	70.00	105.00													141.00						105.00				47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	007	0		29	10	S5983_007_0	5		Y	Non-Preferred Drug	4	11	1	1	4	1		111	01		100	1				30	60	90	2	2						90	30		31											78.37	50	50	50				63.24	50	50	50												50						50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	007	0		29	10	S5983_007_0	5		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4		N	Preferred Generic	2	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4		N	Generic	2	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	27.00																			4.50	9.00	13.50																9.00				9.00		.30			0.15			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4		N	Preferred Brand	2	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	28.00	56.00	84.00																			28.00	56.00	84.00																28.00				28.00		0.93			0.93			0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4		N	Non-Preferred Drug	2	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				63.41	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	4		N	Specialty Tier	2	11	1	1	5	1	010		01			1	30														30		31				309.96	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6		N	Preferred Generic	4	01	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	6		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			2.50	5.00	7.50																5.00				5.00		0.17			0.08			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6		N	Generic	4	01	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			2.50	5.00	7.50																5.00				5.00		0.17			0.08			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	6		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	120.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				73.65	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	6		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				293.40	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_007_0	4		N	Preferred Generic	4	01	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_007_0	4		N	Generic	4	01	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			5.00	10.00	15.00																10.00				10.00		0.33			0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_007_0	4		N	Preferred Brand	4	11	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_007_0	4		N	Non-Preferred Drug	4	11	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				62.31	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	007	0		29	10	S5993_007_0	4		N	Specialty Tier	4	11	1	1	5	1	010		01			1	30														30		31				389.17	30																																					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	8		N	Preferred Generic	2	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	8		N	Generic	2	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	8		N	Preferred Brand	2	10	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				73.00	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	8		N	Non-Preferred Brand	2	10	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				104.00	44	44	44																				44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	8		N	Specialty Tier	2	11	1	1	5	1	010		01	010		1	30								30						30		31				463.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	8		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	8		N	Preferred Brand	4	10	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				53.00	18	18	18																				18															18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	8		N	Non-Preferred Brand	4	10	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				62.00	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				706.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	003	0		29	10	S6506_003_0	8		N	Preferred Generic	4	01	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	003	0		29	10	S6506_003_0	8		N	Generic	4	01	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	003	0		29	10	S6506_003_0	8		N	Preferred Brand	4	10	1	1	3	1	111		01	100		1	30	60	90				1	2			90				30		31				56.00	18	18	18																				18															18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	003	0		29	10	S6506_003_0	8		N	Non-Preferred Brand	4	10	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				73.00	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	003	0		29	10	S6506_003_0	8		N	Specialty Tier	4	11	1	1	5	1	010		01	010		1	30								30						30		31				616.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											42.00	84.00	126.00				45.00	90.00	135.00				47.00				42.00			1.57	1.40		1.40	1.50	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	001	0		29	10	S6946_001_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	002	0		29	10	S6946_002_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	003	0		29	10	S6946_003_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	004	0		29	10	S6946_004_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	005	0		29	10	S6946_005_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	006	0		29	10	S6946_006_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	007	0		29	10	S6946_007_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	008	0		29	10	S6946_008_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	009	0		29	10	S6946_009_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	010	0		29	10	S6946_010_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	011	0		29	10	S6946_011_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	012	0		29	10	S6946_012_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	013	0		29	10	S6946_013_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								3.00	6.00	9.00					1.00	2.00	3.00											3.00	6.00	9.00				1.00	2.00	3.00				3.00				1.00			0.10	0.03		0.10	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					3.00	6.00	9.00											6.00	12.00	18.00				3.00	6.00	9.00				6.00				3.00			0.20	0.10		0.20	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					45.00	90.00	135.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				45.00			1.57	1.50		1.57	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	37	37	37				45.00	37	37	37										37	37	37				37	37	37			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	014	0		29	10	S6946_014_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	32	32	32				45.00	32	32	32										32	32	32				32	32	32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	015	0		29	10	S6946_015_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	016	0		29	10	S6946_016_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											3.00	6.00	9.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.10	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											6.00	12.00	18.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.20	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	017	0		29	10	S6946_017_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	018	0		29	10	S6946_018_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										37	37	37				37	37	37			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	019	0		29	10	S6946_019_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	020	0		29	10	S6946_020_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	021	0		29	10	S6946_021_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	022	0		29	10	S6946_022_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	35	35	35				45.00	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	023	0		29	10	S6946_023_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											3.00	6.00	9.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.10	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											6.00	12.00	18.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.20	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				45.00	90.00	135.00				47.00				42.00			1.57	1.40		1.57	1.50	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										37	37	37				37	37	37			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	024	0		29	10	S6946_024_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	025	0		29	10	S6946_025_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	34	34	34				45.00	34	34	34										34	34	34				34	34	34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	026	0		29	10	S6946_026_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	35	35	35				45.00	35	35	35										35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	027	0		29	10	S6946_027_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	36	36	36				45.00	36	36	36										36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	028	0		29	10	S6946_028_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00	12.00	18.00				1.00	2.00	3.00				6.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	9.00				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4		N	Preferred Brand	2	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00	94.00	141.00				42.00	84.00	126.00				47.00				42.00			1.57	1.40		1.57	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4		N	Non-Preferred Drug	2	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.00	33	33	33				45.00	33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	029	0		29	10	S6946_029_0	4		N	Specialty Tier	2	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											446.00	25	25	25				446.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	030	0		29	10	S6946_030_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	030	0		29	10	S6946_030_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	030	0		29	10	S6946_030_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	030	0		29	10	S6946_030_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	38	38	38										50	50	50				38	38	38			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	030	0		29	10	S6946_030_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	031	0		29	10	S6946_031_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	031	0		29	10	S6946_031_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	031	0		29	10	S6946_031_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	031	0		29	10	S6946_031_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	031	0		29	10	S6946_031_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	032	0		29	10	S6946_032_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	032	0		29	10	S6946_032_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	032	0		29	10	S6946_032_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	032	0		29	10	S6946_032_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	42	42	42										50	50	50				42	42	42			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	032	0		29	10	S6946_032_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	033	0		29	10	S6946_033_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	033	0		29	10	S6946_033_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	033	0		29	10	S6946_033_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	033	0		29	10	S6946_033_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	44	44	44										50	50	50				44	44	44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	033	0		29	10	S6946_033_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	034	0		29	10	S6946_034_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	034	0		29	10	S6946_034_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	034	0		29	10	S6946_034_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	034	0		29	10	S6946_034_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	41	41	41										50	50	50				41	41	41			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	034	0		29	10	S6946_034_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	035	0		29	10	S6946_035_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	035	0		29	10	S6946_035_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	035	0		29	10	S6946_035_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	035	0		29	10	S6946_035_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	035	0		29	10	S6946_035_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	036	0		29	10	S6946_036_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	036	0		29	10	S6946_036_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	036	0		29	10	S6946_036_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	036	0		29	10	S6946_036_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	43	43	43										50	50	50				43	43	43			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	036	0		29	10	S6946_036_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	037	0		29	10	S6946_037_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	037	0		29	10	S6946_037_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	037	0		29	10	S6946_037_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	037	0		29	10	S6946_037_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	38	38	38										50	50	50				38	38	38			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	037	0		29	10	S6946_037_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	038	0		29	10	S6946_038_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	038	0		29	10	S6946_038_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	038	0		29	10	S6946_038_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	038	0		29	10	S6946_038_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	41	41	41										50	50	50				41	41	41			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	038	0		29	10	S6946_038_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	039	0		29	10	S6946_039_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	039	0		29	10	S6946_039_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	039	0		29	10	S6946_039_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	039	0		29	10	S6946_039_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	35	35	35										50	50	50				35	35	35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	039	0		29	10	S6946_039_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	040	0		29	10	S6946_040_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	040	0		29	10	S6946_040_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	040	0		29	10	S6946_040_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	040	0		29	10	S6946_040_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	040	0		29	10	S6946_040_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	041	0		29	10	S6946_041_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	041	0		29	10	S6946_041_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	041	0		29	10	S6946_041_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	041	0		29	10	S6946_041_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	41	41	41										50	50	50				41	41	41			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	041	0		29	10	S6946_041_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	042	0		29	10	S6946_042_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	042	0		29	10	S6946_042_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	042	0		29	10	S6946_042_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	042	0		29	10	S6946_042_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	44	44	44										50	50	50				44	44	44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	042	0		29	10	S6946_042_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	043	0		29	10	S6946_043_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	043	0		29	10	S6946_043_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	043	0		29	10	S6946_043_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	043	0		29	10	S6946_043_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	043	0		29	10	S6946_043_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	044	0		29	10	S6946_044_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	044	0		29	10	S6946_044_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	044	0		29	10	S6946_044_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	044	0		29	10	S6946_044_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	044	0		29	10	S6946_044_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	045	0		29	10	S6946_045_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	045	0		29	10	S6946_045_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	045	0		29	10	S6946_045_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	045	0		29	10	S6946_045_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	045	0		29	10	S6946_045_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	046	0		29	10	S6946_046_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	046	0		29	10	S6946_046_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	046	0		29	10	S6946_046_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	046	0		29	10	S6946_046_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.00	50	50	50				55.00	41	41	41										50	50	50				41	41	41			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	046	0		29	10	S6946_046_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											280.00	25	25	25				280.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	047	0		29	10	S6946_047_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	047	0		29	10	S6946_047_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	047	0		29	10	S6946_047_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	047	0		29	10	S6946_047_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	42	42	42										50	50	50				42	42	42			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	047	0		29	10	S6946_047_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	048	0		29	10	S6946_048_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	048	0		29	10	S6946_048_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	048	0		29	10	S6946_048_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	048	0		29	10	S6946_048_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	42	42	42										50	50	50				42	42	42			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	048	0		29	10	S6946_048_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	049	0		29	10	S6946_049_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	049	0		29	10	S6946_049_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	049	0		29	10	S6946_049_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	049	0		29	10	S6946_049_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	42	42	42										50	50	50				42	42	42			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	049	0		29	10	S6946_049_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	050	0		29	10	S6946_050_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	050	0		29	10	S6946_050_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	050	0		29	10	S6946_050_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	050	0		29	10	S6946_050_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	050	0		29	10	S6946_050_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	051	0		29	10	S6946_051_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	051	0		29	10	S6946_051_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	051	0		29	10	S6946_051_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	051	0		29	10	S6946_051_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	051	0		29	10	S6946_051_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	052	0		29	10	S6946_052_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	052	0		29	10	S6946_052_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	052	0		29	10	S6946_052_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	052	0		29	10	S6946_052_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	052	0		29	10	S6946_052_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	053	0		29	10	S6946_053_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	053	0		29	10	S6946_053_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	053	0		29	10	S6946_053_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	053	0		29	10	S6946_053_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	053	0		29	10	S6946_053_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	054	0		29	10	S6946_054_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	054	0		29	10	S6946_054_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	054	0		29	10	S6946_054_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	054	0		29	10	S6946_054_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	054	0		29	10	S6946_054_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	055	0		29	10	S6946_055_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	055	0		29	10	S6946_055_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	055	0		29	10	S6946_055_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	055	0		29	10	S6946_055_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	055	0		29	10	S6946_055_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	056	0		29	10	S6946_056_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	056	0		29	10	S6946_056_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	056	0		29	10	S6946_056_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	056	0		29	10	S6946_056_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	056	0		29	10	S6946_056_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	057	0		29	10	S6946_057_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	057	0		29	10	S6946_057_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	057	0		29	10	S6946_057_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	057	0		29	10	S6946_057_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	057	0		29	10	S6946_057_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	058	0		29	10	S6946_058_0	4		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	3.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	058	0		29	10	S6946_058_0	4		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					3.00	6.00	9.00											20.00	40.00	60.00				3.00	6.00	9.00				20.00				20.00			0.67	0.10		0.67	0.10	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	058	0		29	10	S6946_058_0	4		N	Preferred Brand	4	10	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00				47.00				47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	058	0		29	10	S6946_058_0	4		N	Non-Preferred Drug	4	10	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	50	50	50				60.00	39	39	39										50	50	50				39	39	39			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6946	058	0		29	10	S6946_058_0	4		N	Specialty Tier	4	11	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											514.00	25	25	25				514.00	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.18	22		22				24.54	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											46.07	38						45.94	36												36						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	001	0		29	10	S7126_001_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.55	22		22				24.45	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											48.26	41						48.61	39												39						39					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	002	0		29	10	S7126_002_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											29.98	22		22				27.68	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											46.73	37						47.12	35												35						35					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	003	0		29	10	S7126_003_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											28.62	22		22				26.18	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											52.71	36						51.68	34												34						34					36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	004	0		29	10	S7126_004_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											26.29	22		22				23.55	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.70	41						43.53	39												39						39					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	005	0		29	10	S7126_005_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											28.90	22		22				26.63	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.85	40						44.30	38												38						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	006	0		29	10	S7126_006_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.66	22		22				24.62	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											41.91	40						41.65	38												38						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	007	0		29	10	S7126_007_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.54	22		22				24.77	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											51.51	36						51.49	34												34						34					36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	008	0		29	10	S7126_008_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.66	22		22				24.81	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.21	37						42.49	35												35						35					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	009	0		29	10	S7126_009_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.95	22		22				25.51	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.76	37						43.96	35												35						35					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	010	0		29	10	S7126_010_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											24.90	22		22				22.24	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											45.09	40						44.93	38												38						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	011	0		29	10	S7126_011_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											26.51	22		22				23.71	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.75	40						44.13	38												38						38					40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	012	0		29	10	S7126_012_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											28.53	22		22				25.88	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											45.62	38						45.84	36												36						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	013	0		29	10	S7126_013_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					3.00		9.00													9.00						9.00				9.00				9.00			0.30	0.10				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											26.79	22		22				24.07	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											36.09	39						36.22	37												37						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	014	0		29	10	S7126_014_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.05	22		22				24.34	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.84	39						44.32	37												37						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	015	0		29	10	S7126_015_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.07	22		22				27.15	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.96	41						46.07	39												39						39					41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	016	0		29	10	S7126_016_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.98	22		22				24.90	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											45.39	39						45.46	37												37						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	017	0		29	10	S7126_017_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											25.67	22		22				22.56	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											39.58	39						39.39	37												37						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	018	0		29	10	S7126_018_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											26.55	22		22				23.62	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											43.84	39						43.76	37												37						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	019	0		29	10	S7126_019_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.03	22		22				23.81	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											42.35	38						42.77	36												36						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	020	0		29	10	S7126_020_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.54	22		22				27.49	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											46.69	38						46.57	36												36						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	021	0		29	10	S7126_021_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													6.00						6.00				7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.73	22		22				25.74	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.81	36						43.04	34												34						34					36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	022	0		29	10	S7126_022_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											25.58	22		22				22.90	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											41.59	39						43.50	37												37						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	023	0		29	10	S7126_023_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	3		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	3		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	3		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											28.49	22		22				25.17	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	3		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.59	39						45.23	37												37						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	024	0		29	10	S7126_024_0	3		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													6.00						6.00				7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.92	20		20				25.16	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											48.21	38						47.30	36												36						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	025	0		29	10	S7126_025_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													6.00						6.00				7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											28.43	20		20				25.92	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											49.88	37						49.30	35												35						35					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	026	0		29	10	S7126_026_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											29.74	22		22				27.23	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											47.76	37						48.06	35												35						35					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	027	0		29	10	S7126_027_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											29.50	22		22				26.62	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											48.32	38						48.73	36												36						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	028	0		29	10	S7126_028_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													6.00						6.00				7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											25.15	20		20				23.03	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											45.98	38						45.36	36												36						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	029	0		29	10	S7126_029_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											26.45	22		22				23.51	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											44.69	37						44.82	35												35						35					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	030	0		29	10	S7126_030_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													6.00						6.00				7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											29.11	22		22				26.22	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											46.67	37						45.69	35												35						35					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	031	0		29	10	S7126_031_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													6.00						6.00				8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											30.77	22		22				27.06	20		20												20						20			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											49.22	39						47.48	37												37						37					39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	032	0		29	10	S7126_032_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1		N	Preferred Generic	2	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													0.00						0.00				5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1		N	Generic	2	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													6.00						6.00				7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1		N	Preferred Brand	2	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											27.95	20		20				23.91	18		18												18						18			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											46.75	37						45.46	35												35						35					37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	033	0		29	10	S7126_033_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.03	25		25				41.18	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.21	46						90.89	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	071	0		29	10	S7126_071_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.43	25		25				40.54	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											86.82	47						88.04	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	072	0		29	10	S7126_072_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.73	25		25				40.59	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											91.52	47						92.74	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	073	0		29	10	S7126_073_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.77	25		25				40.42	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											83.93	45						83.09	43												45						43					45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	074	0		29	10	S7126_074_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.09	25		25				40.30	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											87.40	47						90.78	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	075	0		29	10	S7126_075_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.28	25		25				39.78	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											84.99	46						86.90	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	076	0		29	10	S7126_076_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.31	25		25				39.56	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											84.90	47						89.05	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	077	0		29	10	S7126_077_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.78	25		25				40.00	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											88.89	47						88.64	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	078	0		29	10	S7126_078_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.98	25		25				39.69	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											83.81	46						87.18	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	079	0		29	10	S7126_079_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.49	25		25				39.95	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.09	46						88.10	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	080	0		29	10	S7126_080_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.75	25		25				38.42	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											87.00	48						86.10	46												48						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	081	0		29	10	S7126_081_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.05	25		25				40.46	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.22	46						87.71	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	082	0		29	10	S7126_082_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.84	25		25				39.65	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											84.81	46						87.15	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	083	0		29	10	S7126_083_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.40	25		25				38.50	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											89.11	48						87.38	46												48						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	084	0		29	10	S7126_084_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.01	25		25				38.18	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.88	48						89.11	46												48						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	085	0		29	10	S7126_085_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.80	25		25				38.94	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.16	47						87.52	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	086	0		29	10	S7126_086_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.92	25		25				38.34	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											82.51	46						84.21	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	087	0		29	10	S7126_087_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.30	25		25				38.11	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											82.20	47						84.59	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	088	0		29	10	S7126_088_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.89	25		25				38.11	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											83.52	47						85.29	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	089	0		29	10	S7126_089_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.87	25		25				38.05	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											73.43	43						76.19	41												43						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	090	0		29	10	S7126_090_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.12	25		25				39.57	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											87.20	47						88.88	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	091	0		29	10	S7126_091_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											41.46	25		25				38.39	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											81.16	44						81.09	42												44						42					44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	092	0		29	10	S7126_092_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											42.40	25		25				37.92	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											92.08	49						88.80	47												49						47					49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	093	0		29	10	S7126_093_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	3		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	3		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	3		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.61	25		25				38.78	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	3		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											88.66	48						89.08	46												48						46					48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	094	0		29	10	S7126_094_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.75	25		25				40.86	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											82.26	42						80.91	40												42						40					42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	095	0		29	10	S7126_095_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											46.01	25		25				41.68	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											83.10	42						81.72	40												42						40					42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	096	0		29	10	S7126_096_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.66	25		25				41.11	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											89.26	46						90.89	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	097	0		29	10	S7126_097_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.32	25		25				40.72	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											89.68	47						91.49	45												47						45					47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	098	0		29	10	S7126_098_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											44.72	25		25				41.21	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.65	43						83.35	41												43						41					43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	099	0		29	10	S7126_099_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.20	25		25				39.68	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											85.37	46						85.92	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	100	0		29	10	S7126_100_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.04	25		25				41.32	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											89.53	46						90.07	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	101	0		29	10	S7126_101_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											43.89	23		23				39.45	21		21												21						21			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											83.95	46						89.38	44												46						44					46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	102	0		29	10	S7126_102_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	1		Y	Preferred Generic	4	01	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					0.00		0.00													0.00						0.00				8.00				8.00			0.27	0.00				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	1		Y	Generic	4	01	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													6.00						6.00				10.00				10.00			0.33	0.07				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	1		Y	Preferred Brand	4	11	1	1	3	1		110	01		100	1				30		90	1	2						90	30		31											45.19	25		25				41.95	23		23												23						23			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	1		Y	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											71.24	38						73.28	36												38						36					38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7126	103	0		29	10	S7126_103_0	1		Y	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.44	20	20	20				35.61	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											72.25	36	36	36				64.38	32	32	32										36	36	36				32	32	32			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											814.82	25						741.20	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.78	20	20	20				34.39	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.75	35	35	35				65.31	32	32	32										35	35	35				32	32	32			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											737.80	25						667.79	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.80	20	20	20				34.88	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.94	39	39	39				64.21	34	34	34										39	39	39				34	34	34			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											676.99	25						744.06	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.33	20	20	20				29.42	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.95	31	31	31				51.28	28	28	28										31	31	31				28	28	28			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											825.72	25						903.59	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.31	20	20	20				35.03	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.04	33	33	33				60.04	29	29	29										33	33	33				29	29	29			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											709.40	25						648.80	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.17	20	20	20				33.85	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.43	39	39	39				64.11	34	34	34										39	39	39				34	34	34			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											704.73	25						736.56	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											47.20	20	20	20				35.96	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.10	41	41	41				74.08	37	37	37										41	41	41				37	37	37			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											627.04	25						674.24	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.75	20	20	20				35.36	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											86.00	37	37	37				64.47	32	32	32										37	37	37				32	32	32			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											631.96	25						724.90	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											43.76	20	20	20				33.48	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											87.46	39	39	39				70.11	34	34	34										39	39	39				34	34	34			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											732.51	25						637.74	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											39.12	20	20	20				32.21	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.82	32	32	32				58.86	29	29	29										32	32	32				29	29	29			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											618.21	25						684.17	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.09	20	20	20				29.78	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											63.08	31	31	31				51.61	28	28	28										31	31	31				28	28	28			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											677.06	25						742.74	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.04	20	20	20				35.92	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											73.05	39	39	39				69.77	34	34	34										39	39	39				34	34	34			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											709.10	25						707.20	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											44.49	20	20	20				34.15	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.08	37	37	37				70.02	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											773.54	25						617.50	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.87	20	20	20				37.49	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											70.50	37	37	37				66.15	33	33	33										37	37	37				33	33	33			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											696.79	25						699.99	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					6.00	12.00	18.00											17.00	34.00	51.00				6.00	12.00	9.00				17.00				17.00			0.57	0.20		0.57	0.20	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											43.89	20	20	20				33.28	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.80	26	26	26				46.15	25	25	25										26	26	26				25	25	25			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											746.03	25						635.18	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					6.00	12.00	18.00											19.00	38.00	57.00				6.00	12.00	9.00				19.00				19.00			0.63	0.20		0.63	0.20	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											43.02	20	20	20				31.94	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											53.76	26	26	26				46.90	25	25	25										26	26	26				25	25	25			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											683.42	25						718.30	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											36.01	20	20	20				29.03	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											52.99	29	29	29				43.80	25	25	25										29	29	29				25	25	25			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											577.09	25						685.93	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.05	20	20	20				29.95	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											62.25	31	31	31				49.44	28	28	28										31	31	31				28	28	28			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											720.88	25						770.14	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											44.05	20	20	20				34.11	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											74.02	32	32	32				58.26	29	29	29										32	32	32				29	29	29			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											505.11	25						732.28	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											40.15	20	20	20				31.10	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											79.10	37	37	37				60.83	32	32	32										37	37	37				32	32	32			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											602.79	25						700.63	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.28	20	20	20				36.81	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.86	37	37	37				69.36	33	33	33										37	37	37				33	33	33			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											710.36	25						681.99	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											37.44	20	20	20				31.05	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.27	37	37	37				53.54	32	32	32										37	37	37				32	32	32			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											732.56	25						744.94	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											35.52	20	20	20				28.47	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											65.81	33	33	33				46.84	28	28	28										33	33	33				28	28	28			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											766.33	25						817.98	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.66	20	20	20				28.99	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.48	38	38	38				61.04	33	33	33										38	38	38				33	33	33			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											681.82	25						666.55	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											44.20	20	20	20				29.96	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.88	29	29	29				49.88	26	26	26										29	29	29				26	26	26			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											886.35	25						882.08	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.18	20	20	20				32.95	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.37	28	28	28				46.19	25	25	25										28	28	28				25	25	25			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											660.05	25						715.03	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											42.58	20	20	20				32.25	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.82	31	31	31				51.79	27	27	27										31	31	31				27	27	27			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											723.27	25						741.75	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											36.12	20	20	20				28.05	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.99	32	32	32				51.02	29	29	29										32	32	32				29	29	29			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											588.04	25						684.98	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											41.75	20	20	20				31.41	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											82.45	40	40	40				65.43	35	35	35										40	40	40				35	35	35			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											785.91	25						797.53	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.76	20	20	20				33.93	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											55.21	32	32	32				51.56	28	28	28										32	32	32				28	28	28			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											759.95	25						778.93	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.50	20	20	20				33.88	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											76.57	33	33	33				67.98	29	29	29										33	33	33				29	29	29			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											740.14	25						648.34	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											43.59	20	20	20				34.85	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											77.83	33	33	33				61.74	30	30	30										33	33	33				30	30	30			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											667.93	25						812.97	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											48.52	20	20	20				36.59	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											60.54	30	30	30				53.64	27	27	27										30	30	30				27	27	27			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											685.16	25						664.10	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											39.66	20	20	20				31.89	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											69.63	37	37	37				67.31	34	34	34										37	37	37				34	34	34			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	1		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											642.98	25						663.87	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					1.00	2.00	3.00											16.00	32.00	48.00				1.00	2.00	0.00				16.00				16.00			0.53	0.03		0.53	0.03	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								17.00	34.00	51.00					7.00	14.00	21.00											17.00	34.00	51.00				7.00	14.00	10.50				17.00				17.00			0.57	0.23		0.57	0.23	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											38.47	20	20	20				30.84	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											50.19	28	28	28				42.19	26	26	26										28	28	28				26	26	26			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											737.37	25						756.53	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								18.00	36.00	54.00					1.00	2.00	3.00											18.00	36.00	54.00				1.00	2.00	0.00				18.00				18.00			0.60	0.03		0.60	0.03	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2		N	Generic	2	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	57.00					7.00	14.00	21.00											19.00	38.00	57.00				7.00	14.00	10.50				19.00				19.00			0.63	0.23		0.63	0.23	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2		N	Preferred Brand	2	11	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											40.46	20	20	20				33.51	15	15	15										20	20	20				15	15	15			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2		N	Non-Preferred Drug	2	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.74	44	44	44				75.77	40	40	40										44	44	44				40	40	40			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	2		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											722.88	25						881.58	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.91	50	50	50				73.08	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	121	0		29	10	S7694_121_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1206.82	25						1042.71	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.16	50	50	50				75.24	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	122	0		29	10	S7694_122_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1353.78	25						1058.28	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	123	0		29	10	S7694_123_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	123	0		29	10	S7694_123_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	123	0		29	10	S7694_123_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	123	0		29	10	S7694_123_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											98.14	50	50	50				74.21	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	123	0		29	10	S7694_123_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1363.26	25						1077.94	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	124	0		29	10	S7694_124_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	124	0		29	10	S7694_124_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	124	0		29	10	S7694_124_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	124	0		29	10	S7694_124_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											93.09	50	50	50				76.21	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	124	0		29	10	S7694_124_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1298.29	25						992.32	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	125	0		29	10	S7694_125_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	125	0		29	10	S7694_125_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	125	0		29	10	S7694_125_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	125	0		29	10	S7694_125_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.08	50	50	50				74.32	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	125	0		29	10	S7694_125_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1240.40	25						1035.61	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	126	0		29	10	S7694_126_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	126	0		29	10	S7694_126_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	126	0		29	10	S7694_126_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	126	0		29	10	S7694_126_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.97	50	50	50				74.67	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	126	0		29	10	S7694_126_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1328.94	25						1085.36	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	127	0		29	10	S7694_127_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	127	0		29	10	S7694_127_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	127	0		29	10	S7694_127_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	127	0		29	10	S7694_127_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.33	50	50	50				75.57	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	127	0		29	10	S7694_127_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1217.18	25						1040.41	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	128	0		29	10	S7694_128_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	128	0		29	10	S7694_128_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	128	0		29	10	S7694_128_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	128	0		29	10	S7694_128_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.08	50	50	50				74.48	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	128	0		29	10	S7694_128_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1236.30	25						1048.72	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	129	0		29	10	S7694_129_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	129	0		29	10	S7694_129_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	129	0		29	10	S7694_129_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	129	0		29	10	S7694_129_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.10	50	50	50				75.38	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	129	0		29	10	S7694_129_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1266.68	25						951.66	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	130	0		29	10	S7694_130_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	130	0		29	10	S7694_130_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	130	0		29	10	S7694_130_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	130	0		29	10	S7694_130_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.65	50	50	50				75.74	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	130	0		29	10	S7694_130_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1300.09	25						987.53	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	131	0		29	10	S7694_131_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	131	0		29	10	S7694_131_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	131	0		29	10	S7694_131_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	131	0		29	10	S7694_131_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.84	50	50	50				76.24	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	131	0		29	10	S7694_131_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1358.87	25						956.27	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											97.43	50	50	50				74.39	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	132	0		29	10	S7694_132_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1271.13	25						997.12	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	133	0		29	10	S7694_133_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	133	0		29	10	S7694_133_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	133	0		29	10	S7694_133_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	133	0		29	10	S7694_133_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.80	50	50	50				74.51	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	133	0		29	10	S7694_133_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1208.50	25						1044.91	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	134	0		29	10	S7694_134_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	134	0		29	10	S7694_134_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	134	0		29	10	S7694_134_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	134	0		29	10	S7694_134_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											91.77	50	50	50				75.20	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	134	0		29	10	S7694_134_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1187.00	25						962.31	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											94.35	50	50	50				76.17	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	135	0		29	10	S7694_135_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1231.18	25						981.87	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	136	0		29	10	S7694_136_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	136	0		29	10	S7694_136_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	136	0		29	10	S7694_136_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	136	0		29	10	S7694_136_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											96.89	50	50	50				73.51	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	136	0		29	10	S7694_136_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1263.45	25						1054.43	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_0	1		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					1.00	2.00	3.00											15.00	30.00	45.00				1.00	2.00	0.00				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_0	1		N	Generic	4	01	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								16.00	32.00	48.00					6.00	12.00	18.00											16.00	32.00	48.00				6.00	12.00	6.00				16.00				16.00			0.53	0.20		0.53	0.20	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_0	1		N	Preferred Brand	4	11	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					43.00	86.00	129.00											47.00	94.00	117.50				43.00	86.00	107.50				47.00				47.00			1.57	1.43		1.57	1.43	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_0	1		N	Non-Preferred Drug	4	11	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											95.04	50	50	50				75.49	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	137	0		29	10	S7694_137_0	1		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											1214.11	25						950.73	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	3		N	Preferred Generic	3	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					8.00	16.00	24.00											15.00	30.00	45.00				8.00	16.00	24.00					15.00			15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	3		N	Generic	3	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00					20.00			20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	3		N	Preferred Brand	3	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					40.00	80.00	120.00											47.00	94.00	141.00				40.00	80.00	120.00					47.00			47.00			1.57	1.33		1.57	1.33	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											85.38	50	50	50				85.38	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	3		N	Specialty Tier	3	11	1	1	5	1		010	10		010	1				30								30				10	31											1187.42	28						1187.42	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	001	0		29	10	S8067_001_0	3		N	Select Care Drugs	3	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	3		Y	Preferred Generic	4	01	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	9.00					10.00			10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	3		Y	Generic	4	01	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	30.00					20.00			20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	3		Y	Preferred Brand	4	10	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								45.00	90.00	135.00					38.00	76.00	114.00											45.00	90.00	135.00				38.00	76.00	114.00					45.00			45.00			1.50	1.27		1.50	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	3		Y	Non-Preferred Drug	4	11	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								95.00	190.00	285.00					88.00	176.00	264.00											95.00	190.00	285.00				88.00	176.00	264.00					95.00			95.00			3.17	2.93		3.17	2.93	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	3		Y	Specialty Tier	4	11	1	1	5	1		010	10		010	1				30								30				10	31											740.93	33						740.93	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8067	003	0		29	10	S8067_003_0	3		Y	Select Care Drugs	4	01	1	2	6	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					0.00	0.00	0.00											7.00	14.00	21.00				0.00	0.00	0.00					7.00			7.00			0.23	0.00		0.23	0.00	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S8182	001	0		29	10	S8182_001_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								43.00	86.00	129.00					36.00	72.00	108.00					36.00	72.00	108.00																43.00				43.00			1.43	1.20	1.20			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											100.39	35	35	35				94.65	33	33	33				33	33	33															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	001	0		29	10	S8182_001_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	002	0		29	10	S8182_002_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	002	0		29	10	S8182_002_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S8182	002	0		29	10	S8182_002_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	002	0		29	10	S8182_002_0	3		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S8182	002	0		29	10	S8182_002_0	3		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											24.04	22	22	22				21.85	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	002	0		29	10	S8182_002_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											88.10	43	43	43				81.95	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	002	0		29	10	S8182_002_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	3		N	Preferred Generic	3	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	3.00																6.00				6.00			0.20	0.03	0.03			0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	3		N	Generic	3	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	3		N	Preferred Brand	3	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								40.00	80.00	120.00					35.00	70.00	105.00					35.00	70.00	105.00																40.00				40.00			1.33	1.17	1.17			1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	3		N	Non-Preferred Drug	3	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											100.87	37	37	37				95.42	35	35	35				35	35	35															37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	003	0		29	10	S8182_003_0	3		N	Specialty Tier	3	11	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	004	0		29	10	S8182_004_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	004	0		29	10	S8182_004_0	3		N	Preferred Generic	4	01	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S8182	004	0		29	10	S8182_004_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	004	0		29	10	S8182_004_0	3		N	Generic	4	01	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S8182	004	0		29	10	S8182_004_0	3		N	Preferred Brand	4	11	1	1	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											23.90	22	22	22				21.72	20	20	20				20	20	20															22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	004	0		29	10	S8182_004_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											81.50	41	41	41				77.52	39	39	39				39	39	39															41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	004	0		29	10	S8182_004_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											74.57	50	50	50				67.11	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	005	0		29	10	S8182_005_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	3		N	Preferred Generic	4	01	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					1.00	2.00	3.00					1.00	2.00	3.00																15.00				15.00			0.50	0.03	0.03			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	3		N	Generic	4	01	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								20.00	40.00	60.00					3.00	6.00	9.00					3.00	6.00	9.00																20.00				20.00			0.67	0.10	0.10			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	3		N	Preferred Brand	4	11	1	2	3	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34								47.00	94.00	141.00					43.00	86.00	129.00					43.00	86.00	129.00																47.00				47.00			1.57	1.43	1.43			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	3		N	Non-Preferred Drug	4	11	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		34											71.55	50	50	50				64.39	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8182	006	0		29	10	S8182_006_0	3		N	Specialty Tier	4	11	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	001	0		29	10	S9325_001_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	001	0		29	10	S9325_001_0	9		N	Generic	4	01	1	2	2	1		010	01		010	1				30								30			30		31								12.00							4.00													12.00						4.00						12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	001	0		29	10	S9325_001_0	9		N	Preferred Brand	4	10	1	2	3	1		010	01		010	1				30								30			30		31								47.00							42.00													47.00						42.00						47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	001	0		29	10	S9325_001_0	9		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											46.78	50						40.22	43												50						43					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	001	0		29	10	S9325_001_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											847.04	25						847.04	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	002	0		29	10	S9325_002_0	7		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00				10.00				10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	002	0		29	10	S9325_002_0	7		N	Generic	2	01	1	2	2	1		010	01		010	1				30								30			30		31								13.00							6.00													13.00						6.00						13.00				13.00			0.43	0.20		0.43	0.20	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	002	0		29	10	S9325_002_0	7		N	Preferred Brand	2	10	1	2	3	1		010	01		010	1				30								30			30		31								47.00							47.00													47.00						47.00						47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	002	0		29	10	S9325_002_0	7		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											60.00	50						54.52	47												50						47					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	002	0		29	10	S9325_002_0	7		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											842.76	25						842.76	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	003	0		29	10	S9325_003_0	9		N	Preferred Generic	4	01	1	2	1	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00				7.00				7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	003	0		29	10	S9325_003_0	9		N	Generic	4	01	1	2	2	1		010	01		010	1				30								30			30		31								12.00							4.00													12.00						4.00						12.00				12.00			0.40	0.13		0.40	0.13	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	003	0		29	10	S9325_003_0	9		N	Preferred Brand	4	10	1	2	3	1		010	01		010	1				30								30			30		31								47.00							42.00													47.00						42.00						47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	003	0		29	10	S9325_003_0	9		N	Non-Preferred Drug	4	11	1	1	4	1		010	01		010	1				30								30			30		31											46.78	50						40.22	43												50						43					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	003	0		29	10	S9325_003_0	9		N	Specialty Tier	4	11	1	1	5	1		010	01		010	1				30								30			30		31											847.04	25						847.04	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	004	0		29	10	S9325_004_0	7		N	Preferred Generic	2	01	1	2	1	1		111	01		111	1				30	60	90	1	1				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	004	0		29	10	S9325_004_0	7		N	Generic	2	01	1	2	2	1		010	01		010	1				30								30			30		31								14.00							6.00													14.00						6.00						14.00				14.00			0.47	0.20		0.47	0.20	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	004	0		29	10	S9325_004_0	7		N	Preferred Brand	2	10	1	2	3	1		010	01		010	1				30								30			30		31								47.00							47.00													47.00						47.00						47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	004	0		29	10	S9325_004_0	7		N	Non-Preferred Drug	2	11	1	1	4	1		010	01		010	1				30								30			30		31											59.29	50						55.73	47												50						47					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S9325	004	0		29	10	S9325_004_0	7		N	Specialty Tier	2	11	1	1	5	1		010	01		010	1				30								30			30		31											847.13	25						847.13	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
